A Critique of Alcoholism Treatment Concepts; With Special Reference to Abstinence

Follow-up studies of alcoholism treatment have been so heterogeneous that few reliable conclusions can be drawn about either treatment results or methods. Reported improvement rates have ranged widely, and the commonly used criterion of success, abstinence, may be a grossly misleading measurement of improvement. The epidemiological criteria of alcoholism are reviewed. The milieu of alcoholism has changed over the past 20 years; public acceptance and professional interest have brought different types of alcohol problems to light. Clinical experience and research data demonstrate that the models employed in defining and evaluating alcoholism treatment require modification. Cultural and scientific criteria have been confused and inappropriately applied. They must be correctly assigned to their relevant spheres. Studies of alcoholism treatment indicate the need for a clearer definition of the relationship of abstinence to therapy, the criteria of successful treatment, and the effect of various treatments. Although the studies reviewed do not justify definitive statements, the following seem tenable: 1. Return to normal drinking occurs in a significant portion of treated alcoholics. 2. Improvement in drinking and improvement in social, vocational and psychological adaptation are related but not parallel. Less than total rehabilitation may be the most feasible therapeutic goal in many cases. 3. Abstinence as a necessary condition for successful treatment is an overstatement. It is a prescription which should be used judiciously. 4. Abstinence as a criterion of successful treatment is misleading. It may be maintained at the expense of total life functioning, as in some Alcoholics Anonymous abstainers. Abstinence may also be followed by personality deterioration. 5. The therapeutic efficacy of brief, relatively superficial intervention therapy has been noted. It indicates the need for an evaluation of the nature of psychodynamic alterations which bring such improvement. Bibliography of 110 titles.