Living with Alcoholism: Is Controlled Drinking Possible?

smiling women at a bar with bartender pouring blush wine

Alcoholism is more than just a drinking problem. The condition is marked by symptoms that include compulsive thoughts about drinking, distorted thinking and a lack of control over alcohol consumption. The general consensus on alcoholism is that affected people are unable to return to a problem-free level of drinking, and treatment programs typically focus on complete abstinence. However, some critics of this approach argue that alcoholics can return to a state of controlled drinking with moderate, responsible alcohol consumption.

The Disease Model of Alcoholism

The concept of alcoholism as a chronic medical condition of the brain is known as the disease model. Several aspects of the condition lead it to be classified as a medical illness by the National Council on Alcoholism and Drug Dependence:

  • It is a physical addiction that cannot be controlled
  • It is distinguishable by specific symptoms
  • It requires specialized medical treatment
  • It is characterized by cycles of cravings and withdrawal symptoms
  • The brain is physically altered and functions differently due to continued exposure to alcohol

Designating alcoholism as a disease makes treatment more accessible for affected individuals. However, the implication of chronic illness suggests that alcoholism cannot be cured and that abstinence is the only solution. This notion is debated by some addiction researchers who believe that controlled drinking is a viable option.

The Case for Controlled Drinking

One of the most frequently cited studies regarding controlled drinking is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which examined patterns of alcohol use among 43,000 American adults. The study indicated that 75 percent of participants classified as heavy drinkers recovered without the help of a traditional rehabilitation program or Alcoholics Anonymous. Of those recovering individuals, over half of them had cut back to moderate, controlled drinking instead of abstaining from alcohol.

Alcoholism vs. Alcohol Abuse

Although the NESARC study was groundbreaking, the results were fraught with controversy. The biggest question surrounding the survey involved its definition of heavy drinkers. Were these individuals physically dependent on alcohol, or were they alcohol abusers? One of the central beliefs of Alcoholics Anonymous is that alcoholics are in denial about being in control of their drinking behavior. According to Alcoholics Anonymous and many representatives of the addiction treatment community, anyone who can cut back to a moderate level of drinking was not an alcoholic to begin with.

It's clear that the debate over controlled drinking is a complex issue. The disease model of alcoholism indicates that the condition is chronic and irreversible; with this fact in mind, it's no surprise that abstinence is widely believed to be the only treatment. While controlled drinking may be a realistic goal for problem drinkers who lack a full-blown dependence on alcohol, alcoholics may fare best with an abstinence-only approach to recovery. If you or someone you love is struggling with alcoholism or alcohol abuse, help and hope are available. It's never too late to get started on the road to sobriety.

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