Behavior Therapy - The Hardest Way: Controlled Drinking and Natural Remission from Alcoholism - Behavior Therapy for Controlled Drinking and Natural Remission from Alcoholism

Written by Stanton Peele

Now, Tuchfeld advertises for his subjects. He says, "Come to me and tell me how you quit drinking." So there's a tendency that they're a little bit more dramatic about it than other people out there in the field. The Cahalan and Room (1974) kind of model says people just get out of problem drinking. But even Vaillant's study which looks at people in terms of their natural history finds that people very often report these kinds of epiphanies, these moments of truth. And I think, unfortunately, Vaillant tends to de-emphasize them. It is important to realize that these people may have had moments of truth in the past and gone right on drinking again. However, I think they are telling us something very important about themselves and their values when they describe a moment when they made a very strong resolution to stop drinking.

I've been talking about these people, and I just want to tell you about one of them. Let me introduce you to a guy. This guy's strange, I mean he might not fit into any category we've described today. He comes from a very early study by Genevieve Knupfer (1972) who studied ex-problem drinkers in an epidemiological group. And one of these guys talked about his heavy drinking period. He reported, "I was in the Merchant Marine. Every night or day on shore we'd drink a week or ten days straight. We drank till we fell on our face. We never ate and never slept; I was down to 92 pounds." Bad prognosis for controlled drinking. I think he might be alcohol dependent. He also stated that he was lonely and had no friends — another real negative predictor.

One day he decided to quit this whole life, so he became a cook, and these are Genevieve Knupfer's words: "He became a cook in a cafeteria, a job he continues to hold. He bought a home; he enjoys having it. He enjoys his neighbors and a few friends, but does not seem to be really intimate with anyone. He drinks once or twice a week, never less than four drinks, usually six. He says he never drinks on work nights, but by this he means that he doesn't take more than one drink, and then only to oblige a friend. For example, 'There was a death in the person's family; I had to calm him down a bit; he was all upset. He's an Irishman and I guess they supposedly drink to the spirits. [A little social analysis here.] I just had one drink. He was disappointed because he wanted to go all out.' On New Year's Eve our subject had eight or nine drinks just to go along with the crowd, but he was sorry the next day because he wasn't up to working in his garden."

Now what's funny about this person is that in the post-Rand environment it's very possible that this man might not show up as a controlled drinker, but obviously he's changed, he's changed a lot, he's changed in a way that's really been good for him. He can take just one drink, and if he goes over his limit of six, even to just have eight drinks on New Years he regrets it, and it hurts him. How do we handle such a man as a clinical patient? Would we still identify him as a problem drinker, and attempt to get him to modify his behavior now?

Actually, I think, this man's experience which is unclassifiable by a lot of the categories we've talked about, is a good illustration of something that's true about all kinds of problem drinkers. They're drinking to mediate their experience of life, and their patterns of drinking shift with short and long term needs. They are actually, these human beings, are actually self-regulating organisms however inexact and dysfunctional they at some times may seem. And they're going to remain self-regulating organisms even after they get done talking with us, if they should be so fortunate as to run into us. A particular therapeutic strategy is exactly as effective as this client makes it, and as well as it fits into his internal needs, and his view of himself and his view of his situation. And we may hope to inspire the client, and we, at the same time, can hope to respond to his or her needs, but I think it may be a little grandiose for us to claim any larger role for ourselves in what happens to this person. And I just want to quote one of Barry Tuchfeld's clients. The way he described it was, about people who quit drinking or moderate their drinking, "You have got to have some inner strength, some of your own strength and resources that you can call up in yourself." And, you see, our job is to respect that strength and to respect the individual, enough to support the idea that he has that strength.

References

Armor, D. I., Polich, J. M., & Stambul, H. B. (1978). Alcoholism and treatment. New York: Wiley.

Cahalan D., & Room, R. (1974). Problem drinking among American men. New Brunswick, NJ: Rutgers Center of Alcohol Studies.

Gerard, D. L., & Saenger, G. (1966). Out-patient treatment of alcoholism: A study of outcome and its determinants. Toronto: University of Toronto Press.

Heather, N., Rollnick, S., & Winton, M. (1983). A comparison of objective and subjective measures of alcohol dependence as predictors of relapse following treatment. British Journal of Clinical Psychology, 22, 11-17.

Hodgson, R., & Miller, P. (1982). Selfwatching. London: Century.

Knupfer, G. (1972). Ex-problem drinkers. In M. A. Roff, L. N. Robins, & M. Pollack (Eds.), Life history research in psychopathology (Vol. 2, pp. 256-280). Minneapolis: University of Minnesota Press.

Marlatt, G.A. (1981). Perception of "control" and its relation to behavior change. Behavioral Psychotherapy, 9, 190-193.

Polich, J. M., Armor, D. J., & Braiker, H. B. (1981). The course of alcoholism: Four years after treatment. New York: Wiley.

Sanchez-Craig, M., Annis, H. M., Bornet, A. R., & MacDonald, K. R. (1984). Random assignment to abstinence and controlled drinking: Evaluation of a cognitive-behavioral program for problem drinkers. Journal of Consulting and Clinical Psychology, 52, 390-403.

Schachter, S. (1982). Recidivism and self-cure of smoking and obesity. American Psychologist, 37, 436-444.

Tuchfeld, B. S. (1981). Spontaneous remission in alcoholics: Empirical observations and theoretical implications. Journal of Studies on Alcohol, 42, 626-641.

Vaillant, G. E. (1983). The natural history of alcoholism: Causes, patterns, and paths to recovery. Cambridge, MA: Harvard University Press.

next: Do Antidepressants Work?
~ addictions library articles
~ all addictions articles