Alternatives to Abstinence: A New Look at Alcoholism and the Choices in Treatment

Rating:
Summary: At Last!
Review: A well-written, easy-to-understand review of a very controversial topic. While I'm not 100% convinced that alcoholics can truly learn to drink in moderation, the author raises many interesting points, and this is certainly no work of fluff. A thought-provoker for anyone who has to deal with alcoholism or alcoholics.

Rating:
Summary: Great look at options other than AA
Review: I liked this book because it describes different options than the only one I knew about before I read the book -- Alcoholics Anonymous. As a person who is not particularly religious, the idea of giving up drinking completely AND beginning a new religion at the same time was never going to happen. Now I have some ideas to help me try to cut back, and see if that will work for me. If not, maybe I'll try one of the other groups mentioned in the book. Easy to read, too! Also liked all the web addresses for help and research.

Rating:
Summary: ALTERNATIVES TO ABSTINENCE
Review: King Solomon was wrong. There is something new under the sun. Here we have a book on the moderate drinking vs. abstinence controversy-and it was not written by a professional controlled drinking advocate, nor by a lifetime member of the 12-Step/Alcoholism crusade. Ogilvie said that she did not have any special expertise nor any personal experience with alcohol problems until her publisher approached her about writing this book. Why the publisher, Hatherleigh Press of New York, should be so interested in a book on this subject was not explained. The book is very unlikely to be a best seller. It is known that the alcoholic beverage industry once supported the alcoholism-is-a-disease movement (because calling alcoholism a disease shifts blame and focus from the substance, alcohol, to the victims, the so-called alcoholics). It also seems to me that the industry is now quietly backing the moderation advocates. But the motivations of the publisher, whatever they may be, are totally mysterious.

The book opens with a foreword by A. Thomas Hovath, PhD, a professional therapist and the President of SMART Recovery. SMART Recovery, an alternative to AA, is supposedly an abstinence program, but Hovath makes no secret of his personal and professional preferences for moderation. A decent man who believes strongly in his philosophy of behaviorism, Hovath declares: "Drinking problems do not occur as a result of a disease process. Drinking," he says, "is a learned behavior." Despite this assertion, Hovath's language is almost exclusively that of a healthcare provider. He speaks of "patients" in a "healthcare setting" giving "informed consent" to "providers" who must "honor the patient's rights." All these may all be good things, but his language undeniably shows that this problem, though it's "not a disease," is being thought of in terms that are very much like the medical establishment thinks of diseases and health issues. To the astute reader, Dr. Hovath's foreword reveals that the argument here is not really about "a disease" vs. "not a disease" but about who is going to treat this condition, by what methods, and measuring what outcome.

Following Hovath, a preface is offered by Frederick Rotgers, Psy.D. The tone of Rotgers' essay is much harsher and, some might say, reflective of feelings that are alive in many treatment providers today. In Rotgers' view, those who do not agree with him are members of the "cult of abstinence only." The tenets of which, he believes, are "deeply rooted in the heritage of religious fundamentalism." From his point of view: "To be a 'recovering alcoholic'" - something he apparently is not - "is to have a special status in our society - the status of one who has taken the Devil by the horns, battled, and emerged victorious." Here again, the singular view of the treatment provider should be apparent. To be a so-called "recovering alcoholic" may grant one a "special status" in the world of professional alcohologists, but in "society," in the real world of bankers, merchants, teachers, soldiers, firemen, homemakers, bricklayers and accountants (to name but a few) a "recovering alcoholic" usually has a certain stigma, a somewhat spoiled identity.

Ogilvie recites the traditional arguments of the moderationists. She revisits the nearly forty-year-old paper of D. L. Davis, purportedly revealing that a small number (seven out of 93 or about 7.5 percent) of so-called "alcohol addicts" who had been treated in a London hospital were found drinking "normally." She did not discuss a follow-up study by Griffith Edwards showing that those same "alcohol addicts," twenty years later, were mostly back in their cups. Two of the seven had engaged in "trouble free drinking" over the total period, but five had experienced continued problems with alcohol and other drugs. One had an enlarged liver, one was hospitalized for peptic ulcers, and one poor fellow fell victim to Wernicke-Korsakoff syndrom, the "wet-brain" caused by too much alcohol.

Ogilvie cites several other studies, a superficial reading of which gives the impression that moderate drinking is effortless and common. In fact, the studies only show that moderate drinking is sometimes possible. For thirteen studies between 1952 and 1972, where the number of participants was given, 1,879 "alcoholics" were studied and 228 (about 12 percent) showed some success in moderation. The lengths of the follow-ups ranged from one to eight years, with the most common follow-up period being only one year.

The only positive thing about these data is that the numbers for AA attendees are even worse. Ogilvie cites the generally accepted figure, based on AA's own membership surveys, that 90 to 95 percent of those who begin attending AA drop out within a year. She cites Nick Heather and Ian Robinson, no friends of AA, in estimating that 25 to 50 percent of regularly attending AA members stay sober for one year.

Still, it is not correct to say, as she does (quoting the Rand corporation report), that "some alcoholics can return to moderate drinking with no greater chance of relapse than if they had abstained." Here everyone's thinking has become confused, for if one abstains, one drinks no alcohol and that is that. To think otherwise is for the moderationists to take a page from the "powerless" disease theory they despise, and use it for their own benefit. What is really happening is that of the universe of "alcoholics" who are treated, only a small number chooses to abstain. A much larger number, unfortunately, chooses to try moderate or controlled drinking, and of that number a very large majority will re-experience problems associated with alcohol. Neither side, to the extent that there are sides, can take much pleasure from this phenomena.

Has this book any value? Yes, but mostly as a neutral vehicle that perhaps can be used as a starting point to begin a more productive, more useful, discourse on the whole problem.

Reviewed by L. Allen Ragels

Rating:
Summary: At Last!
Review: Sometimes it seems like 12-step programs have taken over the world! Their adherents zealously insist that the 12 steps/AA is the ONLY way to cope with alcoholism. This book presents a welcome escape from the tyranny of 12 steppers. In a thoughtful, balanced way, the author reports that there really are other answers for alcoholics, answers that might suit some of them much better than abstainence programs do. She carefully examines all sides of the abstainence argument and details a variety of alternative programs. In addition to the very readable narrative, the book contains an extremely valuable appendix that describes more than a dozen different programs/organizations and gives contact information for each as well as a list of therapists who offer moderation training.

Rating:
Summary: Well-researched, dispassionate
Review: This relatively recent compilation of treatment methods for alcoholism is a well-researched summary of alternatives to the popular AA-style abstinence method. The book has an agenda, as will any work on this subject--Ogilvie asks why, in a world where medical treatments are increasingly being tailored to fit the individual, treatment methods for alcoholism other than complete abstinence are so controversial. A very useful resource.