Alcoholism: A Progressive Disease?
Alcoholism has long been described as a progressive disease over which an alcoholic has no control and for which the only effective treatment is complete abstention from all alcohol. The theory that alcoholism is a progressive disease is the foundation upon which Alcoholics Anonymous (A.A.) and other 12 step programs are based.
Writing about alcoholism, A.A. states that “Because the illness progresses in stages, some alcoholics show more extreme symptoms than others. Once problem drinkers cross over the line into alcoholism, however, they cannot turn back.” Or as A.A. usually says more simply, “Once a pickle, never a cucumber.”
We are told that “Addiction and alcoholism are progressive. Use behaviours and symptoms will over time always intensify, and the problem always grows worse” and that “Since alcoholism is a progressive disease, it always gets worse without treatment - it never gets better.”
A.A. insists that there is only one treatment for alcoholism: complete abstention from all alcohol for life. Failure to abstain completely will end in premature death.
However, a half century ago scientific research evidence began to emerge that some alcoholics can learn to drink in moderation, contrary to A.A.’s theory. A study of the effectiveness of an alcoholism treatment program in London found that 7 to 11 years later, 11 of the 93 patients (about 12%) had returned to controlled moderate drinking
These surprising and unexpected findings led psychologists Mark and Linda Sobell to conduct a famous study in which alcoholics were taught how to control their drinking. The researchers found that some alcoholics were successful in doing so.
The findings of the Sobell’s, along with the earlier findings, challenged the very foundation of A.A. and other 12 step programs, all of which are based on the disease progression theory. They also challenged the theory that complete abstinence from alcohol was necessary to avoid descending ever deeper into alcohol abuse and a premature death.
Responses to the Sobell’s evidence were heated and even viscious. Opponents charged the them with misrepresenting their findings and even with falsifying their results. How else, some contended, could these heretical claims be explained? Five panels of inquiry were assembled to examine charges of scientific misconduct, including the U.S. Congress and the American Psychological Association. The verdicts? There was no evidence, much less any indication, of fraud or misrepresentation. Science prevailed over ideology.
In spite of vigorous opposition, the evidence has continued to grow that alcoholism isn’t a progressive disease that, in the absence of complete abstinence from alcohol, leads to premature death. For example, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted a nation-wide study of 43,000 adults in the United States. They found that 17.2% those who had been diagnosed as alcohol dependent (alcoholic) were
drinking alcohol in a controlled and moderate manner. About the same proportion (18.2%) were abstaining. Only 25% of the alcoholics had not moderated their alcohol consumption to some degree.
The NIAAA findings, and those of many other studies, are completely inconsistent with 12 step theories of disease progression, the need of all alcoholics to abstain, and their inability to ever drink in moderation.
Because A.A. insists that alcoholics must completely abstain from all alcohol, it’s not surprising that alcoholics who have never attended A.A. are more successful in being able to drink in a controlled, moderate manner.
Fortunately, not all programs for alcohol problems accept the disease theory and the mistaken beliefs of the 12 steps.
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