NIAAA Official Says Alcoholism 'Isn't Usually' a 'Chronic, Relapsing Disease'
November 19, 2009
The Los Angeles Times notices that people can overcome drinking problems without abstaining from alcohol for the rest of their lives. More important, the Times quotes Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, who admits that the one-size-fits-all, abstinence-only approach preached by Alcoholics Anonymous is inconsisent with the evidence on drinking patterns (emphasis added):
We're on the cusp of some major advances in how we conceptualize alcoholism. The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence....[Alcoholism] can be a chronic, relapsing disease. But it isn't usually that.
Sticklers may question whether a pattern of behavior—in this case, excessive drinking—can ever be accurately described as a disease. But for the treatment establishment, long dominated by A.A.-style thinking, these concessions count as substantial progress. The Times attributes the shift to the findings of the National Epidemiologic Survey on Alcohol and Related Conditions, which has been checking in on a representative sample of 43,000 Americans since 2001. According to the survey, "About 30% of Americans had experienced a disorder...but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less. Only 1% of those surveyed fit the stereotypical image of someone with severe, recurring alcohol addiction who has hit the skids."
The Times understates the significance of these numbers, saying "top addiction experts" now believe that "many drinkers can evaluate their habits and...change those habits if necessary" and that "even some people who have what are now termed alcohol-use disorders...can cut back on consumption before it disrupts education, ruins careers and damages health." What the research actually indicates is that the vast majority of problem drinkers "get better" without treatment. And among those once classified as "alcohol dependent," moderation is about three times as common as abstinence. The scenario that traditionally has been presented as typical—the alcohol abuser who can get his life back on track only by swearing off booze forever—is in fact unusual among problem drinkers.
The psychologist Stanton Peele, an addiction expert who has long questioned the abstinence-only approach to alcohol problems, highlighted the evidence supporting a moderation alternative in the November 2000 issue of Reason.