Disease Theory of Alcoholism - Controlled Drinking

Controlled Drinking

The disease theory is often interpreted as implying that problem drinkers are incapable of returning to controlled drinking, and therefore that treatment should focus on total abstinence. Some critics have used evidence of problem drinkers' returning to controlled drinking to dispute the disease theory.

The first major empirical challenge to this interpretation of the disease theory followed a 1962 study by Dr. D. L. Davies. Davies' follow-up of 93 problem drinkers found that 7 of them were able to return to "controlled drinking" (less than 7 drinks per day for at least 7 years). Davies concluded that "the accepted view that no alcohol addict can ever again drink normally should be modified, although all patients should be advised to aim at total abstinence"; After the Davies study, several other researchers reported cases of problem drinkers returning to controlled drinking.

In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers learning to consume alcohol in moderation. The publication of the study renewed controversy over how people suffering a disease which reputedly leads to uncontrollable drinking could manage to drink controllably. Subsequent studies also reported evidence of return to controlled drinking. Similarly, according to a 2002 National Institute on Alcohol Abuse and Alcoholism (NIAAA) study, about one of every six (17.7%) of alcohol dependent adults in the U.S. whose dependence began over one year previously had become "low-risk drinkers" (less than 14 drinks per week and 5 drinks per day for men, or less than 7 per week and 4 per day for women).

However, many researchers have debated the results of the above studies. A 1994 followup of the original 7 cases studied by Davies suggested that he "had been substantially misled, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data." The most recent study, a long-term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."

The second RAND study, in 1980, found that alcohol dependence represents a factor of central importance in the process of relapse. Among people with low dependence levels at admission, the risk of relapse appears relatively low for those who later drank without problems. But the greater the initial level of dependence, the higher the likelihood of relapse for nonproblem drinkers. (Table 7.8 pg. 152) The second RAND study findings have been strengthened by subsequent research by Dawson et al 2005 which found that severity was associated positively with the likelihood of abstinent recovery and associated negatively with the likelihood of non-abstinent recovery or controlled drinking.