Alcoholism: Disease v. Behavior
Across the world, there are large philosophical differences in the treatment of alcohol dependence. Some look at alcohol dependence as a disease and others see it as an ingrained behavior.
In the United States, the most popular treatment program is Alcoholics Anonymous. Their twelve step program begins with the belief that alcoholism is a disease that prevents one from controlling their consumption of alcohol. The remedy is a series of steps based around complete abstinence.
There a variety of smaller treatment programs that focus on moderation rather than abstinence.
Two of the significant ones are Moderation Management and HAMS (Alcohol Harm Reduction Network).
These start with the assumption that drinking excessively is a behavior that can be controlled through self-control and behavior management techniques.
I saw a very interesting 20/20 special on alcohol-dependence a few years ago.
Through a series of interviews, they demonstrated how vicious the politics between the two methods could be. They interviewed people who lost their jobs for suggesting that medical programs embrace behavioral treatment in addition to strict abstinence ones.
My first inclination is that there are degrees of dependence. Whereas some people may be so drawn to drinking that they literally can't stop once they start, others may be able to control it with behavioral cues.
For example, in the 20/20 special they observed people who had a counting system. They carried around chips in their pockets, each one representing a drink. If they started the program having 30 drinks a week, they would start with 30 chips.
Every time they had a drink, they would remove a chip and put it in their back pocket. When the chips were gone, they couldn't drink. Each week, they would lower the number of chips until it was a reasonable amount. However, the could always choose when they used those chips.
Today, I decided to see what the research shows. Is AA more effective than Behavioral Treatment or vice versa? The National Institute of Alcohol Abuse & Alcoholism did a study between 2000 and 2005 and determined that moderation was effective over the short haul but abstinence had longer term success rates.
They also suggested that the severity of the initial problem was a strong indicator of whether or not they would relapse.
I'm not proposing anyone use one program or another, but think it's important to know about all of the available options. If someone has tried both type of programs and has experiences to report, please share.