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[Drug and Alcohol Findings] (2017) Should dependent drinkers always try for abstinence? London: Drug and Alcohol Findings. Drug and Alcohol Findings Hot Topic (January–March 2017)

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The issue of whether dependent drinkers should always be advised to try for abstinence has been central to alcohol dependence and its treatment for decades. Far from receding into a box marked ‘pointless debates’, prioritising abstinence as a treatment objective has recently returned to prominence as an essential component of influential visions of ‘recovery’. Not so long ago the issue in Britain and elsewhere was not just about what patients should be advised, but whether they should actually be denied treatment until deterioration forced them to accept the need to stop drinking altogether and forever. Here we look at the milestones in this debate, subject to the bitterest controversies ever seen in addiction treatment, while acknowledging that for patients, improvements short of either abstinence or controlled drinking (the non-abstinence alternative described below) may be worthwhile and the best that can be achieved at that point in time.

 

Why such heat over a seemingly innocuous decision between patient and clinician on which form of reduced drinking to go for? In part it was generated by concerns on the one hand that allowing controlled drinking would let alcoholicsassumed constitutionally unable to stop drinking once they start off the hook of non-drinking and set them up to fail, and on the other that insisting on abstinence did nothing to improve outcomes but did limit treatment to the minority of problem drinkersthe alternative being to widen interventions to, and appeal to, less dependent and non-dependent heavy drinkers prepared to countenance a life without drink. Behind this were alternate visions of dependence as a distinct category characterised by inevitable loss of control, or one end of a continuum of learnt behaviour which even at its most extreme can be replaced by learning to drink in moderation………...

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