Re: Abstinence
Bernard:
Regarding ABSTINENCE. In my book, Sobriety Demystified: Getting Clean and
Sober with NLP and CBT, I discuss this issue at length. It is a very sticky
issue, especially in the field of alcoholism treatment, because, as you
pointed out, many counselors in the field are in recovery themselves. The
most widely accepted premise is that total abstinence is mandatory for
complete recovery. While this may be the best course for many, it is
important for anyone treating substance abuse disorders, especially alcohol
abuse, to have clear guidelines to follow.
One very good, if controversial, source is Fingarette's book "Heavy
Drinking: The Myth of Alcoholism as a Disease (University of California
Press, 1988). This book is still available through the University of
California. Fingarette points out that not all "problem drinkers" become
alcohol dependent. This is important, because a number of cognitive
researchers and therapists (Marlett, Ellis, Maultsby, etc.) adhere to the
idea that many people who are NOT alcohol dependent can learn to establish
the cognitive controls to return to "social drinking".
The issue then becomes one of defining "dependence". The World Health
Organization's definition springs from the "old school" concept of addiction
as resulting in withdrawals upon cesessation of use. Newer models of
addiction have incorporated additional criteria, because it is clear that an
individual may become addicted but not suffer physical symptoms of withdrawal
upon cessation (for example, heavy pot smokers may be considered dependent
upon the drug, but do not necessarily go through withdrawals when forced to
quit). The DSM-IV has a whole list of criteria which a dependent person will
exhibit, and does not require evidence of withdrawal symptoms for the lable
dependence to be applied.
When treating for alcohol abuse, as a rule of thumb for the therapist,
however, I usually recommend the work of three researchers, Vuchinich,
Tucker, and Harlee (see "Behavioral Assessment" in Donovan and Marlatt's
Assessment of Addictive Behaviors, Guilford Press, 1988). They rule out
controlled drinking as a goal for any client who has exhibited liver disease,
certain psychiatric disorders, history of pathological use associated with
violence or bizarre behaviors, alcohol dependence as evidenced by withdrawal
symptoms, the client's own request for abstinence as a goal, and lack of
environmental support for moderation.
There is much more to say, but I've taken up too much space as it is. Of
course, the issue becomes more complex when we discuss other drugs or
compulsive behaviors such as certain eating disorders, sexual compulsions,
etc.
Thanks for the opportunity your discussion forum is providing.
Warmly,
-Byron Lewis