ED 158 200-

ANTOORTITLE

INSTITUTSPOOt AGLRCF

*_1313 DATE-VOTE

DRS- PRICEmon

IDENTIFIERS -

ABSTRACT

Nelson{ G.;Ronald G Jansen, William B.Empirical Approaches to the Treatment of AlcoholAbuse: Altertatives,to Abstinence.,Ilabamap Univ., Oniversity.-Dept. of Psychology.National Inst.' of Mental Health (DREW) ,

Md.(77]'52p.

MP -$O.83 MC-13.50 Plus Postage.Adults; *Alcoholism; Counselors;: *Drinking;Literature Reviews; Methods; Program-Descrtp io*Rehabilitation Programs; Research-Methodology;*Social Behavior*Controlled Drinking

This report presents research studies from the past15 years hicb.indicate that some alcoholics have been able to returnto contr fled, moderate drinking_after behavioral treatment.Presente in this report are :. (1) the :techniques used to trainalcohol busers to moderate drinking (2) the research methodologiesused to measure the treatment effects_of controlled drinkingprogram (3) a discussion of the characteristics of controlladrinkin candiates; and (4) two sample optional controlled drinkingprograms. It is hop6d that if treatment with options other thanabstinence is made available, many, alcoholics uho are currentlyuntreated will seek and receive help. (Author/RF)

***** * * ** ** *** *******Reprlductions supplied by ERRS are the best tha

* from the original doCument.********** ******** *********************

******de

EMPIRICAL APPROACHES TO HE TREATMENT OFAl.001.161. ABUSE: ALTEFIMAT, YES TO ABSTINENCE

6"

RONALD 6. NEL OMAN D WILLIAM B. JANZEN

lEmiSsION TO REPRODUCE TRisMATERIAL HAS BEEN GRANTED BY

TO' 71.41 EDUCATIONAL REIDIACESINFORMATION CENTER IERIC) AND

USE Rs OF THESICSY STEM."

W. CI PANTAAINIT OF MOWN,III IfATIDM & PAVANE

NA,IDIOAL INSTI/UTI OFMOTION

Tp4s3 DOCUMENT NAS BO ETA 4E PRO.DU CEO fXACTLy AS RECtiviD FROMTOMENIONDMINAGANIZATION ONION.AT MO IT PcNN1$ OF VIEW OR OPINIONSSTATED CO NOT IldfCESSANILYSPIT ~OFFICIAL NA.TioNwposTITuTE O(E ix itsON gboSa t614 OR POLICY

THIS PAPER wAS SUPPORTED BY THE NATIONAL

II RIME OF MENIAL HEALTH UNDER API NIAAA GRANT,

Traditionally, tb goal of treatment_ of alcoholism hap' been

abstinence.' Total cessation of drinking has been the criterion

for recovery in,themajority of treatment programs -for Years.

Howaver, over the past 15 to 2p years, reports have been, surfacing

Dpthe alcoholism literature suggesti g that alcoholics have been

able to return to "normal" or "moderate"driaking. More recently

data have been reported which indicate that alcoholics have 1:)en

able to, achieve "controlled" drinking aftet behavidral treatment.

These findings have led other s-tb-question many of the basic

tenet_ of the traditional "disease" concept of alcoholism. Thus

a major controversy has arisen in the-alcol lism field; a contra-

hiah ma have come to latel the "controlled drinking

controversy".

Abstinence Only

Central to the abstinence concept in alcoholism treatment has

been its adVocacy-by Alcoholics AnomymouS The stand of "AA"

from its inception has been quite clear, as witnessed by this

statement in the organization's basic text (Alcoholics Anonymous,

1955), "... there is no such thing as _aking a normal drinker out

of an Alcoholic" p. 480). This stand has proven to hold wide-

4

-.Controlled Drinking

-3

spread influence throughout the field, primarily because of AA's

sue ess in helping thous nds of alcohol abusers overcome destructive

lifestyles via "sobriety".

However, AA is not alone in its advocacy of abstinence.

Throughout the alcoholisfi literature of the past 35 yeaFs one finds.ph-

,

almost unanimous support for position that abstinence is the

only acceptable goal for the.recovering alcoholic. In.1941

Strecher insisted, "The highest h

clearing is the acceptance of a -c mpletelymust finally succeed

that _the alcoholic patient

non-alcoholic' fu ' (p. 14). li (1949) strongly suggested

the same, "Because the addict drinker cannots, revert to controlled

drinking, his goal must be permanent a nence" (p. 408)- This

view was reaffirmed by many in the 194- (Bowman, 1956;

1951; and Bacon, 1958).

g iinning in the 1960's fhe "Dean

iebout,

of s the alcohologists"

himself, E. M. Jellenick (1960) , continued the abstin_nce--only.,

trend in. his classic text, The Disease Com p Alcoholism.

Many others followed suit. Glatt (1967) stet d that although

a small :minority of alcoholics may be/able-to return to moderate

drink Abstinence remains the only safe way for the alcohol

addict" (p. 272) The National Institute of Mental Health strongly

supported absiinende in their public statement of 1969, "Most

_hold thatthat`no alcoholic can learn to drink moderately.

and regard statements to the contrary as unwise and dangerous II

This view c-retinues to prevail

4

The National Council

on Alcoholism (NCA, 1974)- has s: ongly'suPported abstinence

throughoUt the 1970's and in a recent review of the contr versy,

fox (1976) emphasized '" ..I think it is very unsafe to advocate

any treatment goal except abstinence" (p. 237). In a

O'Brien (1976) declared we should discourage research

trolled drinkihg because, "abstinence is the beet decision" 4).

_

erate Drinking by Alcoholics

In 1962 Davies,-in his article "Norte Drinking in Recovered

Alcoholics," began'the process of bringing into focus something

which-had been developing for several years an alternative to

abstinence a the only goal in treatment of alcoholism. He found

in a follow-up study of 93 alcoholics seven to 11 years after their

discharges from Maudsley Hospital, London; that even of them had

returned. to "norm-1" drinking. All seven were men who had ex

peri need severe alcohol abuse problems prior to treatment.' Al-

Though he continued to adyise alcohol abusers to aim for to,tal

abstinence, De iee'suggested that the generally accepted view that

hp alcohcil addict can ever again drib normally be modified.

Davies article was not

become normal drinkers.-

first indication that alcollolios might

In 1956 Norwig and Nielson r ported that

42 of 221 former alcoholism patients who were drinking occasionally

were doing well '5140 to five years after treatment. In 1957

Controlled D

5

Pfeffe and Berger found on ollow-tp that seven of_ 60 patients had.

chan g ed their. pattern of-drinking. Selzer and Holloway (1967)

reported that 16% of 83 patrents.had re-tarried to ,"social drinking

fter treatment. Other researchers had reported similarAtindings

(Lemere, 1953; Moore & RamseUr, 1960). But it was Davies article,

which attracted widespread attention -and thus gave rise to what would

later be celled the controlled drinking controversy

Davies article had such impact that 16 leaders Th the alcoholism

field (Various Correspondents, 1961) quickly responded in,a series

of articles. Thefcriticism of Davies was intense. Some suggested

that the incidents he cited were simply "spontaneous recoveries"'

similar to those observed in cancer patients; others insisted- t

his cases;were not true addicts; and still others-.chastized Davies

for the potentially negative -ffect is article might have on sober'

alcoholics.

But the momentum had swung, and soon Several other studie

which concluded that Some alcoholics Could,control their dri

ihg were published. In .1965,, R. E. Kendell in the course

follow-up of 62 untreated alcohol addicts found four who had been

drinking normally for three to eight Years. In 1967 - Bailey and,

Stewart Pound on follow-up of 12 subjects, whom they had earlier class

Pied as alcoholics with some histoty of moderate drinking, six

who were drinking "normally" .Pattiso,n, Headley, Gleser, and

Gottschalk (1968) found in a follow-up study of 32 alcoholics,

Controlled. Drinking

approximately 20 mbn _s; after 4ischarge fro treatment, 11, who had

successfully returned to moderate drinking. Reinert and Bowen

11;68), al=though dloenly skeptical of normal drinking by alcoholics,

diclfind our moderate, drinkers in a sample of 156 alcoholic

patients interviewed one year after treatment at Topeka Adminastra-

tion Hospit 1. And several` other studies'(Kende Stanton,

1966 ;' Pokorny et al., 19687-Orford,et al, 1970; Fi Gerald et

e971; Goodwin, 1971; Kisha Hermann, 1971) proviided' tional

'evidence of "normal " drinking by alcoholics.

Thp most widely known and discussed study which has reported

successful return to drinking by alcoholics is the "Rand Report"

& Stambul, 1976).. While Davies served to stir a

of controversy in the scientific community, the Rand Report

propelled the controversy into the wider professional and lay cm-.,

muniy. The study was a survey designed by the prestigious Rand.

Corporation for the purpose of evaluating the effectiveness of

numerous `treatment centers supported by the National Institute

on Alcohol Abuse and Alcoholism (NIAAA). Questionnaires were

administered to 11,500 men who had sought help at these centers.

The gueslionnaires were-filled out 6 and 18 months after men

?

had completed .tea.tment or been discharged without treatment.

Thee- found that the majority of the former patients described _hem-.

selves not as, long-term'abstainers but as moderate drinkers or as

individuals engaged in alternate periods of drink' and abstention.

Controlled Drinking

The report stated that the results suggest,"...tme alcoholics

can return to moderate drinking with no greater dha-

than if they abstained" (Armor et al., 1976, p VI) .

The Rant researchers welt

7

relapse

rest 4engths to qualify their

statements. They acknowled-d the study' -mall sample.4ze, short

follow-up periods, insisted that labstinence is still. the t tment

of choice, and stated that no sober- alcoholicmhOul&return to

drinking. They pleadedOthat they were simply reporting the fact

that some alcoholics meat 'have stabilized at moderate-drink-

ing levels 18 months after treatment, but this was 119t heard in the

ensuing uproar. The report drew the wrath of the alcholism

"establishment." The iatial Council on Alcoholism, Alcoholics

Anonymous, and numerous other groups, professionals, 'and private

citizens denounced it outright. The report has been rightly or

wrongly blamed for numerous instances of return to drinking by

recovered alcoholics throughout the country. Researcher ave also

criticized the report's methodology, incl ng extended comments

by several authors published recently (Various Correspondents,

1977). Some of the criticisms'include: the over-reliance on self-

reports, the basing of conclusions on a small portion of the total

number of subjects because of poor response to"questionnaires, and

the misleading use of sfat'stios such as masking small numbers with

percentages.

Despite shortcomings, the-Rand 'Report is without question the

Controlled Drinking

8

single event in the history of this controversy that ia.s brought

the issue of Moderate drinking by alcoholics to the layman's

awAieness.

Summary of Follow -up 'Studies

Table 1 presents a summary of the data from the studies we

have reviewed which ted "normal," "social," or "moderate"

drinking by alcoholics.

Insert Table 1 About here

The'-table should be interpreted cautiously in view of the

small sample sizes and questionable follow-up techniques in many

cases. Also, the definition of the "moderate drinker" varies among

the studies'. Despite these reservations, Table I presents s

ficient samples over extended periods to-offer some tentative

Conclusions. First, tine might conclude that in a given population

of alcoholics one would expect approximately 11% to achieve moderate

drinking with or without treatment. This is in agreement with

Patti- n s (1976) estimate of 10-15%. , Consequently, any program

designed to train alcoholics to moderate tFieir drinking would have

to demonstrate a success rate in excess of 11% in order to be judged-

effective. Second, one can conclude that moderate drinking appeared

to be as viable an option for the alcoholic population as abstinence..

Contr lled Drinking

9

There waS no zsignificant 'difference between the percentage of

subjects who succeeded at moderating their drinking and those who

were. able to maintain abstinence 111.-2% vs 11.8%). 'This would

suggest that Moderate drinking might not be as unique an odtcome

as is widely belie.vea. It must be emphasized, however, that well-

are needed in this area beforedesigned, long-term follow-up studies

any f conclusions can be made.

Abstinence ttacked

Explorationin d alternatives to abstinence, initiated by

Davies' article and supported by later reports, to -the critical

examination of the abstinence concept itself and of Jellenick's

(1960) "disease concept" upon which it'wa s based. This latter

concept emphasizes "loss of control" drinking, where one alcoholic

drink initiates a chain reaction so that alcoholics are unable to

only have one or two drinks, but continue drinking: Eo ever, Mello=7)

and Mendelson (1971), after a quantative analysis..of the drinking

patterns of 1- alcoholics given unrestricted access to alcohol,0

concluded that their observations gave no empirical support to the

traditional notion f craving. Merry (1966 ) gave alcohol to alto-

holies disguised as a vitamin preparation and was unable to detect

any, evidence of increased craving for alcohol Sobeli, Sobell.

and Ch5istlman (1972) were not able to determine any evidence of

loss of control in their alcoholic patients after intake of either

4

small or large amounts of alcohol. Gottheil, Alterman, Skoloda

and Murphy (1973). found that 44% of their. alcoholic patients wh

given an opportunity to drink, drank no alcohol at all and 23%

began and stopped, even though zlcohol continue to be available

in the experimental setting. Thus, many researchers have concluded

that loss: of control after _the-first dh irik. is not inevitable and,

have called for a thorough rethinking of the disuse concept

(Robinson', 1972; Davies, 1974; Keller, 1976) .

Pattison (1968, 1976) has attacked the abstinence concept in

several article 'which suggest that insistence on abstinence as the

.sole criterion of succes may prevent alcoholics from obtaining

therapeutic"assistance. Many patients cannot achieve abstinence

and thus avoid returning to counselors with an "abstinence only"

approach. Furthermore, Pattison has stressed that the social,

vocational and psychological -elfare of the patient is as important

as changing his drink,tpg pate -n, and'the assumption that abstinence

will immediately bring improvements in these areas is not warranted.

As evidence Patttis cites Gerard (1962) who found that in 'a/group

of totally abstinent "successes," 43% were "overtly disturbed,"

24% "conspicuously inadequate," 12% "AA addicts" and only 10%

"independent successes." Thus many signifidant and even critical

treatment goals may be eally overlooked when abstinence alone is,P.

emphasized. He also criticizes the abs nence-only approach because

it leads to the punishment or rejection of the nonabstinent

Cor trolled Dtibking,

11

alcohOlicv may drive many discouraged treatment perSonnel out of the

fidld of alcoholism; may be :in itself.preVenting the ;possibility of.

controlled-drinking byA0anyalcoholics; and may be forcing many to-

adoPt-.a.lifestyle in-conflict with,a_society that values ability to

drink. Other authors, (Evans, 1973; Popham and Schmidt, 1976

Canton, 1968; andTreedi-1973) have also come to s4destion abstinence

as the only acceptable goal of alcoholism treatment.

Attein is to Train Alco- lics to Control Their Drink in

Challenges of the abstinence'and the disease-concepts have

resulted in eforts to train alcoholics to become "controlled".

- drinkers. Such efforts a e certainly needed -Alidate the claims

that alternatives to abstinence in alcoholism eatment are feasible.

Until the ,early 1970's when behavioral treatment efforts began, the

critics of the controlled drinking option had-mti h to criticize.

There were many weaknesses in the reports of alcoholics returning

normal drinking. Since the numbers were small and treatment had

not emphasized moderate drinking, the results might just be

"spontaneous remissions" similar to those found in cancer resear

The survey procedures were fraught with problems: results were

often based totally on self-reports and recall of the former patients

which raised the guestiob of validity; interviews were often done

by individuals who provided the treatment which raised the pos-

sibility of bias;. and operational definitions of terms like "normal

dri Win " soci al dxir king ,"

were corn picuous ly alosent< from

This made corap.arison of survey

The 1os -of control ° researchwho insist that the riiod.erataori

hig lily cor c1 1e4 exper-irrten to

alc ohclIcs i in the wor

(Pa iede& , 19 / ) = -thus

des igried

ale

tea= 1 eval

god 16

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"(loin 11" and

12

d adjuistrie Tit"

the survey s ©r were very ane

results pract<i=cally inposs ib le .

has also been criti cited by thoseeyed by aic hoLics L c er title

ccnditioris would be irripo sib le for

wttere 3U&i1

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Controlled Drinking

13

In the second segment the

ects were allowed to drink but were shocked intermittently when

they e'coeeded a specific SAL,.

12 tw hour sessions °vet a lb wok

the subjects comp -et d t1_ t1tteli

he t consisted of six to

period= Twenty-eight of

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Controlled Drinking

14

'ias a basis for firm conclusions. The a,uthors concede this but still

Label these subjects as "complete successes." Second, two-thirds of

the control subjects dropped out of the experimeht. Third, d, the use

of a therapist with an inVeSLment In the outcome to u-diry out_ treat

meat w1 LIl L., t11 the c1Cpc1-1

introduced

up procedure

actually

L1.1 __tiol sAIL_JkAp.b 111 1/.1z

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Controlled Drinking

15

was stithdrawn. after discharge tile subjects were to send in pre-

_addressed postcards containiny specific. i nitor=mmla ti-1 about drinking

171abits. Attempts were alsu made to turL -ui urCte tt11.s information

through Conta- with 11-1ati_ve cYlld LLlti1d5. AL the cild Olt

dO-duy peLlod only Oilc. had

d rniciny and Ltic Ulu L.

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ad d1. LA 131 evid-,.

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ro11ed Drinking

16

chrQn is Mama" alcoholics respectively from the emergency roomsp

f the Baltimore, 11--

meet

_ls, participati an d environ-

made contingent upon dbstiflence or moderate driakina

Each study was of 5-week dura t 1 1t Iid duLin(4 thre!e of the

U

money Iii

td ntt1t5 wr

.111y

alt

2 weks

satic:to

ficid

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Controlled Drin_ in

17

These three studies demonstrated that under extremely, controlled

experimental situations some alcholics can moderate their

habits witwith the aid of riA_id manipulotiQn of wnvitouu _al,

tone --enc rite nes Ltits ly t1 111 eiigt Lh t 11v

1'1 ©t CIlly 01.0 1.

will *lose cOntrol" cat their drinking= The ,utnors u lycst thc11

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Con -oiled Drinking

18

drinking for aA)eriod of time 'after treatment. H s.rver, the-small

sample size, short follow=up period arid relia-1 on self-teporth

during follow -up prevent conclusive

John

In 19 /0 EwIlig

verhity NVIL1-1 Ca

through wh AL 11e No

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patterns. Of the

Controlled Drinking

three were found to he-drinkin

19

in a control=

-:--..,led manher and three ot,her4 'wet doing poorly. wing categorized

such results a "showing premise" tor the possibility of training

-0h014,cS to (IL Ink In

ftuwver, lu a la

conpleted

during c Z 1

contiolled m Mae V_1.,d outpatient t -atment,_

'1E sLudy ut 14

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Control ed Drinking

20

categorized identically to an alcoho ie who dra to excess every

'day. His criterion for success appears to be exorbitantly high, as

witnessed by his statement, ...for the alcoholic, even one bout

of loss of control can be damaging in many ways and, we believe,

-tints a poor outcome of therapy" (Elwiny, 1/ P- 1 31) - Thus

pears that his scoring system is biased toiard failure. It is

also curious that he dropped the MininUM number of needed

for completion of treatment from 12 to lx for tulluw up

Despite the fact that Swing's outcom

Spiead publicity,

Q01-0_1ULle

Svc ik,;eived

Is qustiuncibi tii much (AA,-

dlInk110.3 kk 1,14

ly

.111,d c,c thud

ology, HI did not claim that he was car rying,cu.t a wel l-designed

tiedf..lu i

a !AU

agains L L:01 _

duic, lout 1eliely

Q1.0..o( s1.41

mill. .A.,1 ,_rt1,1

Su

01 11

c4iia

c_ ,A 1 1L,,,

,

LAIC.

v ILA .n't,u,ly

ex (1.,(

Ad:

Controlled Drinking.

21

realistic bar setting at-the hospital. Types and number of drinks

were recorded as well as the number of sips per drink. The re-

searchers found that the alcoholics ordered straight drinks,- gulped

rather than sipped their dri- and ordered more drinkS. In a

later study, (Sobell, Schaefer & Mills, 1972) 2 hospital

alcoholics were compares with 23 social drinkers and the authors

again noted similar behavioral diffeeences between alcoholics and

social drinkers- These studies were impressive in that Lney were

the first systnatiL attempts to det--I dt I

and drinking pat --=lz befuL clay modit1L:aL1L,11 pry

This prtivide s tur individualized tre

111

WL 414

plaits P11,1 1lclaccuracy in measuring t Jneht effects. Subsequently, Mills,

Sobell and Schaefer (1971) designed a treatment Frog -11 t11iou9

which they hujelcd to 111udify by avoidan-- t1ond1 tlu111119 L1A thLe

maladaptive drinking behaviors ides-_Lified in the t dseiill studs ,0

Thirteen "chronic" alcoholics (alcohol abusers who had experienced

withdreiwa1 byw numels,uS /1(.,n

a real stIL: ettin9 11Q6pItol? 11

gulping, heavy aLlukin9 0111 0L la

ish

a

41 elcctilc £11 e1

al ta111 u11 they

size iccalvea

to MudcLate

cd L11,;

1 raa1111 LI4L. k11

14

01 tti cat_ L1_cal

Lit 1 11,3

L I -

44

Controlled Dri_

22

6-week follow -up via personal interview, 12 of the.-1 experimental

subjects and none of the control subjects were found to be drinking

socially and three eNperimental plus two of the control subjects

were abstinent. In a vaguely eported 6- month follow -up, the'

subjects reported more alcoholic behavior including "drunk days"

than during the 6-week follow-up. In a later 12-month foldow-

up reported by Sch (1972) f our of the 13 al L oholi cs

to be drinking socially and three were absti

only two Were t tlen t and none were d1 ink

or social man The t_11,,xs viewed t1 lenultb

t_taup_s wal e

behavioral path Il of drinking acquired by the

edged

Of the controls,

-L seiLiu9. Thcli ,.:;u11 Judea that aleu11.,11cs c

L iry JA.

su,n for arter luant_

Theke

L

t11,_

dIrr.

Y 1 1 pe,

LL011ad

efICOUld,3

;s i n

e Law.

tLil by,

1,_45 ,11 A. 1. t/ 1 9.1..

I, I A, All. 1., L.., ,..i 11 v. 1_411-,1 -L

11/ 1

k LA r L

Ac.

OuLe--1,

LiAQ aLt141.1

L A -

1

1

11u s l 1 I

11.

'A, d Li.

Controlled Drinking

23

the treatment itself. Second, one might question the validity of

using interviews after 6-meth periods which depend on the

-recall of cl its and collaterals in determining post-treatment

drinking patterns. Regular random checks c cried out with shorter

temporal durations Third, Lhe of evctiu

progregs appears to be questionable. Alcoholicsxc were 1 1.4eled

"abstinent" during a 2-wek period even it they hdd been dril.klaay

hao 1, .11 buggeLedhea ly for up to 50is

that e mi4ht question

thu

11611 d olLud

.) 1 toll V 1 d,s4 a L 1p-;1 0 a1,.1

who MIA y.akAl. a4A4 U (1.1 1 a

The S be116

work or tne

" gamma " d1C0hol s the a L to 111c)(.11 c -y

A v > 1 L y ,C

a

111k 111 k

L.

QUM I.A(.,:atIQUI..11

dr.('

L.

al a1 1 Ju

, I 1..."J

C-

I 1 , Lhe , .Ata u 1,

.-oventl,aol U

L

w 1 Lb

ze0 mai.

.paLLeiL.

A a 1

Controlled Drinking

24

groups in all: controlled drinking - experimental (CD-E), controlled

drinking- control (CD-C), non-drinking- _rimental (ND - E), and non-__

drinking-control (ND- C).

Six-month, 12-month (Sobell & obeli, 1973), and 24-month

(Sobell & Sobell, 1976) follow-up studi were carried out. The

follow-ups were done every 3 to 4 weeks via personal contact with

the subject and three to tour coll)ter 1 sources. At each periodic

check ratings of the sub

status, use

were -b-

drinking disposition, vocational

ty supports, and i terpersonal adjustment

Althouyh both expel: ne-t-1 groups apvalc.a Lu I

doiny equally will duLlny the first 12 pion

subjects continued to fu fiction significantly better than theil

ecntL015 thrcuyhuut

Tnc,

all

LAd

ycaL up pL_10....1.

kLLAIL,ly

a10-1 yd ell dealyneil pL,19L-1II t, evaluate ,,,,-Liolted dAlukinq L- daLe

Their eruphasi on

41411,1,

sublect_s uuriny rullow up

-Ii-,t,- l ki-, 1.I,, A,L,Ail,a

Ali, L", i 1 01,_,..1 L 1 1=1._

it Iit .vas 1 1 , ,.. 1 L , ,,-4 I I ..- L. ., k 4 I t .4 ,1 1 ,

10-A ilea J1, , In, ,__,,_ t A A,-,4 k =pi 4 L., I,

than any utnei 6 , 4,41, . Ii,r4 evk_ ti, k 4- a e "--e itmit. ai , ifiAft,

9L.=n ,LeAel

study F lLst, X11, #. x,11 [olio-

Onc OL

11,1 CL \,

4ki, 'A 11

as well as subje-

Controlled Drinking

25

bias in repOrting popiti-e results. Second, since

e-who became controlled drinking subjects initially chose that

particular goal and had either outside social support for such be-

havior or successful experience with social drinking in the past,

there is the possibility that motivation and speQifi- personality

characteristics y be cul,fLulidir1g f

since the c

e

groups received ttadrti

hytllplacebo effects of alLeL

final outcome, Fe u

Adl VI

the ou uittc Th1r

group LtiGlapies and Lbe

ualized ttl,aviural Al tail

albo hnVC played d 1e lit Lite

, (218 Boers (19/4) Lao , IL ila

for distinguishing -drunk" rrol "controllei _ by

011114a Of alcohol_ Ylfth Madam (19 4) tlas L. c!ell A

Subells belzy

when h "dkuith" t-iLo 22 "L LIS dA lllhltl day.n LIc,., .1.-0 ..

yea Ls Lhat.)Ate LLaill alooll only loo d bc.---ube

are belny coulpaked Lo al,oll"il- 4 L 4, 1 0 % 41,4 ,- _s and ,,,,,L Jw.1,i

on a reasoliable 1,1,..1 at. tA4 1,

VukjI,L,

A 1aLa t LuJy

by V..,91cL, t.

Controlled Dri

of well-designed research in controlled drinking begun by the

ing

Hobe lls and others at Patton. The study involved 56 inpatient

26"

alcoholics and was designed to evaluate the effectiveness of a

ccbi.nation of behaviormodification techniques in moderatthg,

alcoho1ics' drinkin4 patterns. Fourteen of the subjects dropped

out of-the study after a few sessions, but _the remaining 42 were

randomly assigned to one of two groups. In group -l. the 23 subjects

were trained by behavioral techniques such as videotaped con-

frontation of intoxicatedbehavior, HAI. discrimination training,

and aversion training for overconsumptio oup-24 which con-;

sisted of 19 subjects and served as a control, received only be-,

havioral counseling and educational procedures. Drinking histories

and baseline drinking sessions were obtained. Inpatient treatment /-

lasted for 4 to 6 weeks and "booster sessions" were held for a

1-year period. Follow -u by personal interview was done by a male

field representative who had no previous contact with the subjects.

He was also blind. regarding treatment. Some subjects who lived at

a distance were contacted by phone or questionnaire. CollateralI

sources were contacted in a similar manner.

During the 12-month follow -u p -iod, seven subjects in each

group were found to be abstinent. Eight subjects from Group-1 and

fo subjects from Group-2 were found to be "controlled" drinkers,

OT

Controlled Drviking

.27

i.et,,average intake of leas than 50 ounces per -nth and no more

than one uncontrolled episode per month) and .a total of 16 "relapsed"

(eight in each group). In analyzing between-group differen9es in

specific drinking and drinking-related behaitiors, the authors found I

_k

that Group-1.1ost significantly fewer days from work and consumed

less alcohol. They cOncluded.thatbeHavior modification techniques

can be effective in moderating alcoholics drinking patterns over a

1 year period.

This research is i pressiye for several reasons: e, utiliza-

tion of random ass nment, 4 control group, baseline drinking ses-

'siont, a follow- nterviewer not directly connected with the study,

and operational definitions. One could argue that a definition of

controlled drinking which permits one uncontrolled drinking episode

monthly is too liberal. .eiloWever, the study does add support to

the controlled drinking alternative.

Another similar research project by this group (Vogler, Weissbach

& Compton, 1977) was done later but on an outpatient basis with

subjects whose drinking problems were less severe and whose families

and jobs were relatively intact. Many of these "problem drinkers"

were referred to the study as a result of the legal consequences of

drinking, prticularly drunk driving. Eight subjects participated

and were divided.intofour groups. Group-1 (23 subjects) received

videotaped feedback of drunken behavior, aversion training for over-

--consumption,

Controlled Drinking

28

discrimination training, alternatives training,

behavior counseling and alcohol education; Group-2 (19 subj cts)

received only the latter four methods; Group-3 (21 subjects) re-

ceived alcohol education only, and Group-4 (17 subjects) only

received the last three methods. The objective was to compare

the effectiveness of various combinations of behavioral treatments,

a condition missing from all other studies. The subjects were. 4

interViewed 'monthly. by-a field representative during a 12-month-follow-

Rperioci. At 12 months 50 (62.5%) of the 80 Subjects were found

to be "moderate" drinkers (intake less than 50 ounces absolute

.alcohol per month and no more than one drinking episode per month

during which the BAL exceeded 80 mgs.) and three (4%) were found to

be abstinent. No significant difference was found between groups.

The alcohol Antake,of subjects who received only alcohol education

was equal to that of subjects who received all the behavioral.

methods.

The most significant contribution of this study, besides its

positive outcome, is its attempt to discern the behavioral techniques

which were most effective in training alcohol abusers to moderate

their drinking. However, the study demonstrated that alcohol

education provided in one-half the time was just as effective as

behavioral treatments. The data suggest the possibility that be-

havioral techniques may be no more effective in training the moderate

alcohol abuser to control his drinking than education and counseling.

#Controlled Drinking Studies

Controlled Tyr irk ing

29

The number of well-designed research projects on controlled

rig reported in the literature is minimal but growing., A

nuer of the studies have suffered from lack of control grOups,

o anal definitions and pretreatment drinking baselines.i Other

criticisms include inadequate follow-up procedures, absence of

statistical analyses small sample sizes, and in some cases con-

clusions which are simply not supported by the data.

Despite existing difficulties in comparing the studies, Table

2 presents a summary of those studies using comparable dependent

measures and having a follow-up. Conclusions drawn from this table

must be tentative; but it does appear that researchers are reporting

Insert Table 2 about here

significantly higher success rates (43.3%) in training alcoholics

to control their drinking than the base rate of 11% obtained in

Table 1. This suggests that alcoholics can be taught to moderate

their drinking. Furthermore, a significant percentage (13.9%) of

the subjects'in controlled drinking studies are attaining abstinence.

This percentage is at least equal to abStinence rates found

abstinence oriented treatment programs.

e Charact6ris ics of the Controlled Uri Candidate?

veering this question has been extremely difficult through-

out the period of this controversy. Back in 1963 Selzer (various

correspondents, 1963) commented, "...as for the problem of distinguish-

ing the alcoholic who ultimately returns to normal drinking from

his more numerous fellows, I find myself at a loss" (p. 113).

'Trying to identify the significant personality characteristics of a-1

good controlled drinking candidate has been especially frustrating.

The Sobells (1973) found no significant correlation between partic-

ular personality characteristics and success at controlled drinking

in their studies, and Vogler et al. (1975) also did not. Popham

and Schmidt (1976) and Pattison (1968) found that educational

background, employment status and sex were not helpful predictors.

There is agreement among some researchers that pretreatment

level of consumption may be a good predictor. Popham and Schmidt

(1976) concluded that this was the only reliable predictor and thus

suggested controlled drinking only'for patients with a relatively

low pketreatment Consumption level and abstinence for the heavy

drinkers. Vogler et al. (1975, 1977) obtained similar results.

Orford (1973) and Orford et al. (1976) have reported that the success-

dul controlled drinking subjects reported less symptomology at

31

Controlled -brinking

Intake. However, Pattison (1968) found that symptomolc

31

intake'

was very similar in alcoholics found later to be abatinent,,con-

trolled dri -ers, or pathological drinkers.

Numerous researc rs believe that a.helpful predictor may

the alcohol abuser's present extentiof social support: support of

_family, friends and employer,. Strickler et (1976) concluded

that support of spouse and family was crucial and the Sobells (1973)

made adequate-social. support one prOrequisite for admission into

(1968) con

be the key,factors in

their controlled drinking experimental group.

citded that social competence and support may

return to normal dr ink hg, and -Lovibond and Caddy (1970) made con-

certed -efforts to include in treatment ,the familymembers of their

controlled drinking subjects.

Thus, there remains disagreement and speculation as to what

characteristics facilitate controlled drinking. Certainly more

research needs to b_ -dole before any firm conclusions can be drawn.

Tentatively, one might conclude that pretreatment consumption level

and extent of social support are probably significant factors.

Should Con-olled Drinkinf be Recommended

Th second question touches the core of the present controversy.

Sinc the amount of quality research on this issue to date is

limitep and the findings tentative, why consider controlled drinking

for anybody? Probably the best response is to note that.so many

alcohol abusers fail at abstinence. Orford et al. (1976) found in

a 2-year follow-up bf, 50. alcoholics that only 2% had been able X

_actually follow the total abstinence route, and eventually this

tentage became zero. Valiance (1965) ,obtained a similar result

in his 2 -year follow-up study. Pattison (1976) and others have

stressed that insistence on abstinence may prevent many from even

accept.seeking treatment, because it is a goal they simply will not

many may want_help., t , .$ee tot41.,44PO,Pence.Wtoo radical a step

.for them.

ISus, here may be an incalclable number of alcohol . abusers

who are not receiving treatment because of the insistence on

abstinence. This could be a good criterion for determining who

should become a controlled drinking candidate. As Pomereau et al.

(1976) have suggested, maybe the best candidates at this time for-

controlled drinking are those alcohol abusers who have continually

failed at abstinence or simply will not accept abstinence-oriented

treatment. It is obvious that the needs of these indiViduals

deserve to be met and they must, by definition, be met outside the

present abstinence - oriented treatment methodology.

It could be that in utilizing the above criterion, we will

discover the most appropriate candidates and also a possible

resolution to the controlled drinking controversy. Such a criterion

does not suggest that those who are succeeding at abstinence or

willing to try it should-do otherwi e. However, for those who

continually fail after numerous attempts, or simPl 't accept

an abstinence goal, here- -is an alternative.

For those who would c ndemn this suggestion out of fear hat

any attempts at implementi_g.controlled-drinking programs will- de-

crease the number of abstainers, there are some preliminary in-

ditators. that controlled drinking programs may actually increase.

the number of abstinent altoho ics while teaching some to moderate

their drinking. The Sobells (1V7 3). commented on .a peculiar phenone on

in their results.: a good number of their controlled drinking,

subjects chose abstinence in-the end. Vogler et Al. (1975) were im-

pressed with the large number of subjects who became abstinent in

spite of the moderation orientation of ,their study. In almost every

study reviewed iu the previous- section, a significant number of con-

trolled drinking subjects chose abstinence. PA. plausible explanation

for this phenomenon is that after making sincere effort at Utili:2ng

the behavioral techniques to control their drinking, some-of the

subjects simply became convinced that for them abstinence was the

only way., If this is true, the controlled drinking alternative-may

assist some alcoholics t o moderate their drinking while actually.

airing -other alcoholics to become abstinent.

For those who claim that any attempts at implementing such

programs would covertly encourage individuals with relatively mild

drinking pro

of thdir problem,

Controlled Drinking

to continue drinking and increase the seven

,would suggpst that the exact opposite may

34

y

actually be the case. As strong a case can be made for the idea

that alternatives to abstinence will encourage individuals wits

Jets severe drinking rcbl ems for seek treatment-before they, reach

chronic al cpholism status. Many persons on the. road to severe prob-

lems might consider methods of controlling

before the more dpttic abstinence goal.

their alcohol consumption

controlled drinking,

option could lead to the prevention ofmore serious alcohol abuse

through the teaching of moderating techniques.at a stage*when the

chances of success are high (Strickler et al., 1910.

In addition we have a commitment to treat the impoverished

cohol abuser who has minimal social support. However, we often

.

punish him for his pathology by not permitting him to remain An

residential treatment centers (half-way houses),when he drinks.

However, the great majority of chronic alcohol abusers will drink

and thus place themselves outside the care of traditional alcoholism

treatment. The controlled drinking alternative may be an answer,

to this dilemma. Facilities which would adcept the.fact that these

individuals will drink, and thus not insist on abstinence but at-

tempt to shape the residents' drinking into more constructive

patterns, may have the potential of reaching these individuals when

traditional abstinence-oriented facilities would not. Thus, con-

trolled drinkin does not have to be in competition 'with an

abstinenae orientation but

the number alcohol abusers being treated, and.thereby increase.

the number of !'succeSses," in the form of:, abstinent or controlled

c10. kers.

can work cooperatiVely and increase

It may be premature to del neat e an ideal controlled drinking

program i \light of the minimal amount of quality esearch that has

been done in this area -However, the idespread that many

alcohol abusers -are not receiving-treatment demands that we begin

to conceptualize and implement such programs. After reviewing the4

literature at least two treatment programs are suggested. fie first

(Program A) would be offered for the alcohol abuser who still has

significant social support and stability (home, family, and job)

And the second (Program By would be offered for the chronic, im-

poverished alcoholic with minimal social support. Bdth progra

would include procedures for referral to abstinence treatment

consistent failure at o eration is experienced. In neither

program would a person be punished through termination for excessive

alcohol abuse. Beginning both programs with inpatient treatment

might be preferable because it provides an opportunity for intensive

application of techniques over a short duration. However, Progra

A. would utilize outpatient area

Controlled- Drii: ing

36

ent becausemoSt moderate alcohol

abusers, for which this-program i designed, would probably not

accept admission to inpatient care. Furthermore, some success

lat training alcohol abu to control their drimking.in an'out-

patient setting has been onstrated (Strickl6r 'et al., 1976,

Vogler -et al.,- 1977). Program B would utilize an in tial inpatient

setting due to the chronic nature of the alcohol problems of the

population for whickit is designed' and the.laak of social support

for'imOst of- them.

Program A.:,....Thi progra n wouldlo gp( :with -intensive-twice-

weekly otiutpatient sessions to educate the alcoholic about the aversive

effects of'excessive alcohol intake and,to introduce behavioral

techniques to be implemented for modifying drinking patterns. During

the initial period the clients would complete detailed drinking

baselin and drinking histories. Subsequently, maladaptive

drinking patterns'would be identified. Individualized treatment

plans would then be implemented to alter the maladaptive drink

habits (gulping, ordering "straight" drinks; drinking alo

stopping at bar daily after work).

Various-b -avioral techniques would be utilized in assisting the

alcoholics to achieve their individualized weekly treatment goals.

This would involve behaVioral education to modify specific ex-

cgssive drinking ha -its, training to develop coriptructive response

Controlled Dr i iki n

repertoires to situations which previously provoked exces1ive

drinking (stimulus control), and modeling of mode to drinking be-

havior by therapists }as well .as role-playing by Clients 'of socially

acceptable dr ing behavior (Sobell and Sobelr, 1973). Modeling

37

a

and traininTwogld take_ place in a simulated barrOom setting.

AVersiOn training would =be implenented. for maladaptive- drinking,

habits (Mills- et .al., 1971) as well as videotaped feedback of

=drunken behaviOr at special sessions (Sobeli and Sobell, 1971).

We are not convinced that-blood alcohol level (BAL) estimation has

l.

'._demonstrated much promise.and t would not be used in thi8 program%

Besides the: training and practicing of moderate drinking behavior

which would take place in the twice-weekly sessions, clients, would-

be -given specific'uhomework" involving maintenance of Agreed-

upon levels of consumption, practice of moderate drinking habits

At home or in social situations,-and practice of new constructive

responses to situations whiff prseviously provoked excessive drinking.

Spouses, relatives, or friends attending the sessions with the

clients would assist in onitoring.the completion of this homework.

In some cases contracts with souses -could be utilized to formalize

the spouses' role in supporting the clients' attempts at modifying,

drinking patterns (Miller,-1972). The thrust of this second phase

of treatment is to attempt to utilize- operant techniques,in a

multi-modal approach to decrease excessive drinking behavior and

Conttolled,Drinking

F

increase moderate drinking beheiriOr. This was-the common goal of

8

the most successful and-well-designed controlled drinking studies

reviewed earlier.

The third and final phase of .treatment would involve a gradual

decrease in fre uency.of sessions and an increase in emphasis on

generalization of moderate drinking behaviors to the home and. work

situation_.. sessions would shift to weekly and then .monthly

and fina ly intermittent "boo ter" -se Seions when-needed. In turn,

greater ttress would be placed on evaluation of homework _setting

of long-term.goaLs, and d veloping_therole of significant others

to support the clients' efforts. Sessions would be held with

spouses- and relatives to encourage them in theiitical roles and

provide them with necessary training to effectively" deal with the

.clients behavior (Cheek, 1971) The "booster" sessions would provide

remedial help for those clients 6xperiencing difficulties (Vogler

et al., 1975)..

Program B. This program would begin on a inpatient basis since

t would be serving alcoholics with long-term alcoholism histories

who also lack social support. The program would have a/contingency

management-orientation similar to the program Cohen et al. (1971a)

utilized successfully with skid-row alcoholics. The alcoholics

would earn the righ participate in an "enriched environment" and

to obtain spending money .(Cohen et al., 1971b) by moderating their

drinking. Behavioral techniques including videotaped feedback of

Controlled Drinking _

39

n behavior and aversive conditioning for over-consumption,

would be used to assist the clients in achieving and Maintaining

moderation. Aftela designated period-of inpatient treatment,

alcoholics who do not moderate their drinking would b'e encouraged

towards abstinence.

Those who Succeed in moderating their drinking in an 'inpatient

setting would be transferred to a half-way house where similar

- contingency managementproceduret would be available. Moderate

drinking would be permitted In the house but abstinenc_ would be

required when on pass in the community. Tarticipation in an en-,.

-niched' 'enVironMeht would be withdrawn for drinking on pass or ex-

cessive drinking in the house. However, the alcoholic would not be .

refused admiSsion into the house-because of excessive drinking.

Hopefully, as Cohen et 44. (r971a) have conjectured, mod9atedrink-

ing opportunities in the house would serve to reinforce:abstinenCe

in the community. Drinking would be restricted to one room in the

house in an effort to shape "social drinking habits. Eventually4

residents would `attempt moderate drinking the community under

supervision. This would not-be'allowed until's stable moderate-

drinkihg pattern ws established in the house.,

There exists fear that giving alcoholto a coholics in such

setting would lead to chaos. 0n the contrary, Paredes-et al. (19T4)

found that introducing al-cohol into an open ward setting did not

Controlled Drinking

40

increase the attrition rate or the amount of aggressive behavior

among residents. Those who continue to do well in the half -way

house would be given vocational counseling, assistance in finding

employment, and encouragement to find independent living quarters.

Booster treatment would be available as needed.

_

Final Comment

The controlled dLi f cuntkoversy ha a relatively briet

history and i s probably tar from resolved. ualQuality experimentation

in this

However, it is also widely suspected that thousands of al-

is minimal to date d thus the issue .nemain6 ou ver-

I O6

ent

leatd because uf the lack of optiulis in aloof 116m

tut, si ilk ;-,.3 1 vt LC) i 1 ,jlt1It LL uA Llttent

options other Lhan abstiti ttce and LO training capable staff in al

tentative techillyus, tun gulled drinking programs such a_

thy or , YisideiationIn Pi_u,jtaiil A Ina b ak L I

Controlled Drinking

41

References

Alcoholics Anonymous. (2nd e- New York: Alcoholics Anonymous

World Services Inc. 1955, 575 pp.

Armor, D. J., Polich, J. M., Stambul, H. B. Alcoholism and Treat-

ment, Santa Monica, California. Rand Corporation, 1976.

Bacon, S. D. Alcoholics do not driink.

Academy of Political and Social

The Annals of American

Sbience, 1958, 315: 55-64.

Bailey, M. B. and Stewart J. Normal drinking reported by persons

reporting previous problem drinking. Quarterly Journal of

Studies on Alcohol, 1967, 28: 305-315.1

Bigelow, G., Cohen, C., LiebSon, and Faillace, L. A. Abstinence

or moderation,' choice by alcoholics. Behavior _ --arch and

Therapy, 1912', 10, 20 9 214,

Bowman, K. M. The treatment of alcoholism.

Alcohol, 1950, 318-324.

Canter, F. M. The reqUiLemehr of at,: t1ncuc as a problem la

Journal

institutional teatme -rit of alcoh

1968, 42: 217-231.

Chalmers, D. K. Contro11ec3 dLi kiL

atr c Quarielly,

oholisffi t

goal: a note on research methodology. NCAL Report #NCAL0147o4

_ Iry ne: University of California, 19/4.

Cheek, F. E. Franks, C. M., Laubius, Bintle, V. hen vikJ,c

modification training for wives of alcoholics QU rt_11y

Journal Studies on Alcohol, 1971, 32, 456-401.

Controlled Drinking

42

Cohen, M., Liebsen, I., Faillace, L. A., and Allen R. P. Moderate

drinking by chronic alcoholics: a schedule dependent phenomenen.

Journal of Nervous and Mental Disease, 1971a, 153, 434-444.

Cohen, M., Liebsen J. A , and Faillace, L. A. Alcoholism, controlled

drinking and incentives for abstinence. Psychological Reports,

1971b, 28, 575-580.

Davies, D. L. Normal drinking Iii recovered alcohol addicts.

Quarterly Journal of tudies on Alcohol, 1962, 23, 94-104.

Davies, D. Is alcoholism really a disease Contempor ary

Drug P-oblems, 1974, 3, 197 -212.

Evans, M= Modification of dr'ukiny, Journal of Alcoholism, 1973,

8, 111=113,

1

,,ouLrolled Lehay.i.,r lu

on Alcoholism and Related Aadic:tion, 1973 c3, 64 75

b c_11a v 1 of a l appLua rJ1 proLl&._ al

1 1. Lc.L. 1141 1 tnul_ I t a 1 ±± t 1 16,.; t

Lw16,J, J.

----------6t1111t= recent aLLeiL11:.L_ Lc 161 261_

16 patle6

blew Yt l k Academy 1 6,

A. e

16,i I it

EWI6kj,

or AddiLtio 3 1 1 4

1 6

1974 399.

-.1 1

n

11,41., 231 1 11 154_

.AAk

Control Drinking

43

zgerald, B. J., Pase -fork, R. A., Clark, R. Four-year follow-

up of alcoholics treated in a rural hospital. Quarterly

Journal of Studies on Alcohol, 1971, 32, 636-642,

Fox, V. Controlled drinking controversy. JOurnal of

American Medical Association, 1976, 236, 863.

Freed, E. X. Absti for alcoholics reconsidered. Journal

Alcoholism, 1913, 8, 1U6 -11U.

Gerard, D. L., Saenyel,

Archives Aeral Psy

Glatt,

Goudwin,

Kell

M. The question cif mod

Linent l ut,uIIL:

1962, 6, 83-95.

drinking debi,11,,..; Uf

BriLlan Jc,ui 1, 1 of Addiction, 1967, 62, 20/ --4_

1 1. di 1

eight. yk=lai Jultin_i Or on

1971, 32, 130-14/

tl

Al

Al1t_ILM11

_ _ 1 .1. 1 1 ..

ut eayk...:111a k ; 11 / 3 1 JO 4

k,

oil eye and t Iv laic_ c_nO, 19Uk.

or -0 t_uu 4, A1 11 /u 3

Kendall, R. N I drinking A.y t ..,.i,.... .4.

Quart 1 1..Ju1. na1 ./.E tit ,,,11 ,_,, A1.-.1,11-1 1

Udall, lt. E 6

Quarterly Jocurnal t atnale,a un aleu1, -1

fAut...i 1

1160, 30 41

all

Controlled Drinking

44

Kish, G. B. Hermann, H. T. The Fort Meade alcohol treatment

program: Studies onfollow-up study. Quarterly Journal

Alcohol, 1971, 32, 628-635.

What happens to alcoholics? American Journa

Psychiatry, 1953, 109, 674-676.

Lloyd, R. W. and Salzberg, H. C. Controlled social drinking: an

alternative to abstinence as a treatment goal for some alcohol

abusers. Psychological Bulletin, 1975, 82, 815 -842.

Loin, G. The addictive drinker. Quarterly Journal of Studies on

Alcohol, 1949, 10, 404-414.

Lovibond, S. H. and Caddy, Discriminated aversive control in

the utoderation of alcoholics drinking behavior.

Therapy, 1970, 1, 43/ 444.

Madsen, W. The American Alcoholic: The nature-nature Uori-

Behavior

troversy in alcoholic research and therapy, Springfield,

:ha-les Thomas, 19 4

Mello, delson J. H l -1 iv. JLILtNlitg

patterns in alcutlolIt A1,..:111Vuo owlutc.21 i'yt_thlral_t_./ 1971,

29,

Mat-ry, J T.t1 ,1 HI, 11,11,c. .00

Millet, M. ,,1 let, ._. \,1.JL i ,A L111 11, IL. t. i tka Litillt, t,,E

+11.

C ISEtt 1 e1,av lot Therapy 19/, 3, 91 A=

reinfor ce

hcLbelt, M., EiSlei,

t ot 1 (.d blood al.,t)

chronic alcoholi Behavior Res ear

11,9 Cif

levels in

and Therapy, 1974, 12, 2r 1 203.

Controlled Drinking

45

Mills, K. C., Sobell, M., Schaefer, H. H. Training social drinking

as an alternative to abstinence for alcoholics. Behavior

Therapy, 1971, 2, 18-27.

Moore, R. A. & Ramseur, F. Effects of psychotherapy in an open

ward hospital on patients with alcoholism. Quarterly Journal of

Studies on Alcohol, 1960, 21,'233 -252_'

The National Council on Alcoholism. position Statement Regarding

Abstinence. News elease, July 19, 1974.

National InStitute on Alcohol Abuse and Alcoholism.

Alcoholism: The illness, the sympt- the treatme=nt=

Department of HEW, Pub. No.(ADM), 74-128, 1972.

National Institute of Mental Health. Alcohol and Alcon,,lism_

PHS Publica _on N 104u, Wa 1969

Norvig, J. & Neilson, B. A. A follow-up study c f 421

addicts in Denmark. Quarterly Journal of Studies on Alconol,

1956, 17, 63i 644.

O'Brien, P. Controlled dL

Alcohol Affairs, 19

Or rd, J. Compat

uncontrolled and ttiv dr

Behavior ReseaLc:11 and Thlaky, _

Or -rd J., Oppentilmer,

the outcome tor e

Behavior 1

1 1 1 y

la wa1111y Lit,11e

11 3O !.)/(_,

Edwakds c AI, 1111

di hike, L Wa, yUQ1-0 a_

alid '1:LLptt 19/o, 1 4U9 410

Controlled Drinking

46

Paredes, A. Abstinence versus controlled drinking: which

goal? Physicians' Alcohol Newsletter, 1972, 7, 1-4.

Paredes, A,, Gregory, D. & Jones, B. Induced drinking and social

adjustment in alcoholics. Quarterly Journal of Studies on

Alcohol, 1974, 35, 1279-1293.

Pattison, E. M., Headley, E. B., Gleser, Lam= C. & Gottschalk, L. A.

Abstinence and normal drinking an assessment of changes in

drinking patterns in alcoholics after treatment. Quarterly

Journal of Studies on Alcohol, 1968, 29,1610-633.--a

Pattison, h. M. A critique of di-

special reference to abstinence. Quarterly Journal of Studies

on Alcohol, 1960,1 J, 4 /I=

Patt_lbui 1 M 14kJ1141_,S 1111, i, I. I" t_11

alcon-i10 5.-.51_

Psy _cLry, 1976,

efeffel, L

QUarteLl 1--L1-11

A I 1

1111,-.a1 Ly

h. L-IloW-,

Ai L'hl Lit ,3 11e1 cil

11/5411,551 L-1

Contr011ed Drinking

47

Popham, R. B. & Schmidt, W. Some factors affecting the likelihood

of moderate drinking by treated alcoholics. Qilou_rnal

of Studies on Alcohol, 1976, 37, 868-882.

Reinert, R. E. & Bowen, W. T. Social drinking following treatment

for alcoholism. Bulletin of Menninger Clinic, 1968, 32,

280-290.

Robinson, D. The aldoholOgis addiction: Some mpllcations of

having lost control over the disease concept of alcoholism.

Qua

Schaefer,

behaviors 11 alcoholics and social drinkers, kinds of drinks

and sip magnitude. Behavior Research and Therapy, 1971, 9,

23-28.

Schaefer, H. H. Twelve-montn rollow-up of behavlucally

ex-alcoholic social drinkers. Behavior Therapy, 19/2,

-289.

--ly Journal of Studies Alcohol, 1972, 33; 1028-1042.

Sobell, M. & Mills, K. Baseline drinking

Sel£ _ilowa, v,4

couuttitLil to a state 110S

Alcohol, 1957

Silverstein,

estimatiQn and

U

1

QuoLLLI/ Jolil., ©1 ut ' miles

Td-y1-k

Behavior Therapy, 1974, 1°15.

Sobell, L.

drink. Behaviur RaeQL1a The 19i2, l i 119 12-

Controlled Drinking

48

Sobell, M. B., Schaefer, H. R. & Mills, K. C. Differences in

baseline drinking behavior between alcoholics and normal drinkers.

Behavior Research and Therapy, 1972, 10, 257 -258.

Sobell, M. B. & Sobell, L. C. Individualized behavior therapy

for alcoholics. Behavior Therapy, 1973, 4, 49-72.

Sobell, M. B. & Sobell, L. C. Alcoholics treated by individualized

behavior therapy: one year treatment outcome. Behavior

Research an01.1tEpy, 1973, 11, 599-618.

Sobell, M. B. &.Sobell, L. C. Evidence of c ntirelied dlinking by

former alcoholics: a second year evaluation of Individualized

behavior therapy. Behavior Research and Therapy, 1976, 14,

195-216.

6 erect

Quarte

A LhLUIII _ A1.otlt 11. m a pby,,Lolt--JI.-al sl

Journal of Studies on Alcohol, 1941,

Strickler, D., Bigelow, G., Lawrence, C. & Liebsen

Va

dL 1 IL altc1.1Ital.

ulic-

Idauaba.

3

buleavikJkal llama and ihei

Thu Lille ut pny,...thlai-y 11, LI1c ti.

kit

17.

Modeiie

14, 2/9

al-. nokl

ly 19:31 12

thu iti

BritiSh Jouknal of Pay.±niat,/ 19o5 ,

A A .vi

Controlled Drinking

49

Various Corrspondents. Normal drinking in recovered alCOhol

addicts (comment)by Various C espondents),

of Studies on Alcohol, 1963, 24, 109-121, 321-332, 727-735.

Various Correspondents. The "Rand Report", some comments and a re-

sponse. Journal of Studies on Alcohol,' 1977, 38, 152-194.

Vogler, R. E., Compton, J. V= & Weissbach, T. A. Integrated be-

havior change techniques for alcoholic, our--I of Constai_LL.al

and Clinica 1211AL112129_y, 1975, 43, 233-243.

Vogler, R. E., Weissbach, T. A. & Compton, J. V. iniQytated tJe-

havior Change te-hniques for problem d rinkel:s L; own

Journal of Consulting and Clinical ho]ogx 1977, 45,

267-279.

Table 1

Percentage of Moderate Drinkers and Abs)ainers

Found During Various Follow-up Studies

Study DateNo. %

SubjectsModerateDrinkers Abstainers

Follow-upPeriod

bemere 1953 500 11% RecordReviewa

Norwig & 1956 221 19% 17%, 2-5 yrs.aNielsonPfeffer & 1957 60 8% 80% 4 yrs.aBergerSelzer & 1957 98 12% 18% 6 yrs.aHollowayMoore & 1960 100 St 15t 3.5 yrs.aRamseurDavies 1962 93 7.5% NA 7 -11 yrs.a

Kendell 1965 62 6.5% NA 3-8 yrs.ba

Kendell & 1966 6 8t 15% 4 15 yrs.StantonBailey 4 13, 4t 5 yrs. b=

StewartPattison 1968 32 Jilt 14% 1 5 yrs.b

Pokornyet al.Reinert a

1968

190b

88

1'Jc

26% 28%

tut

1 yr.a

BowenFitzgeralaet al.

19/1 4

Goodwin i J 71 tot 4tU

:L

Kish 4 1971 17J 5t iLt

Hermann1.

Orfordet al.Rand

19 /b 100 10t

lut gutLA

Uo4 Lt.

Note: The totals do ::mot ini_:luje the 1):: ii9Oz) (1965)studies because abstinence data was :.ot avallai,le (NA)

aafter treatment

bafter no treatment

Table 2

Percentage of Moderate Drinkers and Abstainers

Found During Follow-ups of Controlled Drinking Studies

Study DateNo.

Subjects% ModerateDrink ers Abstainers

Follow-upPeriod

Lovibond & 1970 31 67.7% 1-8 mos.Caddy

Silversteinet al.

1974 4 25% 0% 2 5 mos.

Strickleret al.

1974 0% 6 mos.

Ewing 1975 11 0* 42.9% 5 yrs.

Mills et al. 1971 13 30.8% 23.1% 1 yr.

Vogleret al.

1975 56 21.4% 25% 1 yr_

VutAlrer al.

1 9 / / QZ 4t

Tutalb 104 lj 91S