In order to achieve abstinence the alcoholic/addict needs to make major lifestyle changes. Like all followers of any pursuits, alcoholics often mix with others who share their lifestyles and goals of sobriety, generally through self-help or mutual help groups.  However, if sobriety is to be maintained in the real world then change is required.

Maintaining abstinence

Maintaining Abstinence

In order to achieve abstinence the alcoholic/addict needs to make major lifestyle changes. Like all followers of any pursuits, alcoholics often mix with others who share their lifestyles and goals of sobriety, generally through self-help or mutual help groups.

However, if they are to live in the wider world outside self-help groups, they are liable to come into contact with people drinking alcohol. Non-alcoholic friends may be supportive and not actively encourage the alcoholic/addict to indulge.  But, just being in the company of others who are getting intoxicated, or even just consuming, can represent a major temptation to relapse. Because of this, the alcoholic often fears that his/her social life will be over and it may take a considerable length of time until they feel that they can socialise at all, and even longer if alcohol is present. Thus, total abstinence is a difficult goal to maintain, at least initially.

Alan Marlatt, an American psychologist, highlights a second problem of this goal. In his research on relapse he suggested that the inflexibility of the goal led to a belief on the part of the alcoholic that any drinking, regardless of how slight, was proof positive of their helplessness and could lead to a return to full-blown alcoholic relapse. He argued that this outcome was not a physiological process stemming from a disease. He suggested that it was in fact a psychological process, arising from a belief in the disease model and the need for complete abstinence.

He called this phenomenon the ‘abstinence violation effect’. Thus, someone who has remained abstinent for over a year and then took a drink may believe this to be a total failure of having broken their sobriety. They would probably not recognise the very substantial reductions they had achieved in consumption and frequency of consumption having been abstinent for a year. This belief of being a ‘failure’ he argued can lead the drinker to continue drinking and have a full-blown relapse.

Other Goals
Recognition of the difficulty of such a black and white goal as abstinence led other clinicians and researchers to suggest alternative goals. Thus, other goals, such as moderation management, harm reduction and controlled use, have entered the treatment repertoire of addiction treatment.

The best known, or most infamous, of these alternative treatment goals is controlled drinking. Research evidence began to emerge in the 1960s that suggested the disease model of alcoholism was flawed (as alcoholics were found to be recovering without treatment AND had been found to be drinking in moderation and safety). So, in a famous experiment in the 1970s, Mark and Linda Sobell carried out a study to test the feasibility of teaching controlled drinking to alcoholics.

The study caused a scandal at the time, but it was also a success, although not necessarily in the manner that was expected. Over some years a number (four) of people in the controlled drinking treatment condition died, and this became a matter of heated public debate in the media. Accusations were made against the Sobell’s that they were killing alcoholics, or more accurately, encouraging alcoholics to kill themselves by encouraging them to drink.  However, it was generally ignored that over the same period a greater number (six) of people in the conventional treatment also died.

There was a further twist to this story.  The Sobells writing about the study some decades later, pointed to the fact that, many of the controlled drinking group had in fact ended up opting for abstinence. Their interpretation of the results of the study was that

a/ controlled drinking was possible for some alcoholics, although it was then and currently still is impossible to predict who would be successful in controlling drinking

 b/ that stopping drinking entirely was the more common outcome, even if the initial goal was controlled drinking

c/ that treated patients were more likely to remain abstinent when they felt that they had been given a choice of outcome. They argued that this choice appears to give the patient ownership of the goal and hence ensured greater adherence to it.

Choices

For Some Abstinence is Necessary
While we can speak about alternate goals and choice, for some people there are sound medical reasons why abstinence is essential. In cases where there is severe liver damage and further consumption of alcohol will only exacerbate the problem, stopping drinking is strongly recommended. Similarly, for patients with severe cognitive impairments due to Wernicke’s encephalopathy or Korsakoff’s psychosis further consumption will only increase the damage. Thus, there can sometimes be very good grounds for abstinence for health reasons and in cases where moderation cannot be achieved. Nevertheless, even under these circumstances it is a difficult goal to maintain. Although we acknowledge this difficulty, it can be achieved and millions of people throughout the world, including some major celebrities, achieve and maintain abstinence daily.