First cracked in 1960s London, the orthodoxy that abstinence is the only feasible treatment goal for ‘alcoholics’ seemed shattered in 1973 by evidence that even physically dependent patients could learn to drink in moderation. Controversy was fierce, reaching the US Congress, TV networks and the courts. Explore the history and contested research behind an issue facing every dependent drinker starting treatment. 

Contents

 1 Why the heat?
The controlled drinking issue and why it aroused such passion.

MILESTONES

 2 A gentlemanly start
In early 1960s London, psychiatrist D.L. Davies opened up the first telling crack in the abstinence-only consensus.

 3 The gloves come off; the Rand report
Support for the feasibility of controlled drinking in a 1976 US report was likened to “playing Russian roulette with the lives of human beings”.

 4 The Sobells decisively crack the abstinence consensus
Published in 1973, findings from the hard-to-explain-away solidity of a randomised trial showed successful treatment of US patients need not conform to abstinence-only orthodoxy.

 5 Sobells in the firing line
The heat is turned up in a bitter and decades-long controversy over the Sobells’ findings.

CONTEMPORARY EVIDENCE

 6 Evidence accumulates and expert opinion converges
The heat dies down as it becomes clearer that both controlled drinking and abstinence have their place, that neither has a definitive advantage as a treatment goal, and as evidence emerges about what types of patients do better with either strategy. Three major UK and US trials confirm the feasibility of controlled drinking as a treatment destination, one best handled by less severely dependent and psychologically vulnerable patients with social support for moderation.

 7 Who takes the decision and how?
With both objectives on the care-planning table, shared decision-making between client and patient has become the recommended way to decide.

 8 What do the authorities say?
Guidance from Britain’s National Institute for Health and Care Excellence and from the Department of Health’s National Treatment Agency for Substance Misuse accepts controlled drinking as a goal for less severely dependent patients or when abstinence is rejected.