Ten Radical Things NIAAA Research Shows About Alcoholism - Alcoholism Treatment is Not Necessary for Recovery

Written by Stanton Peele

(8) Elaborate alcoholism treatment is not necessary for recovery; most alcoholics in the United States recover without treatment. MATCH indicated that people who seek to overcome alcoholism and have a supportive social environment can well do so with brief therapeutic interactions that focus their motivation and resources on improving their lives. The NLAES analysis of untreated alcoholics shows (a) that most alcoholics do not seek treatment and (b) that most of these stop abusing alcohol (Dawson, 1996).

(9) Nonabstinent remission is standard for American alcoholics. Not only do most alcoholics improve significantly without treatment, but they typically do so without quitting drinking. According to NLAES, from five years following a dependence diagnosis on, a majority of ever-alcohol-dependent people in the US are drinking without manifesting alcohol abuse/dependence. Untreated alcoholics are more likely to be in remission than treated alcoholics at all points since dependence onset because, although they are less likely to abstain, they are far more likely to drink without diagnosed problems.

On September 8, 1997, U.S. News/World Report ran a cover story on controlled drinking (Shute, 1997, September 8). Gordis responded in the magazine (September 29) that "current evidence supports abstinence as the appropriate goal for person with the medical disorder 'alcohol dependence' (alcoholism)." Yet Gordis touted MATCH's excellent outcomes consisting of a reduction in the frequency and intensity of drinking by alcoholics! NIAAA's MATCH and NLAES results defy the irrational claims this agency (and American alcoholism treatment) make about abstinence as the desired—if largely unobtainable—goal for all alcoholics.

(10) The clinical tool used for the medical diagnosis of alcoholism confounds those who most strongly endorse the medical treatment of alcoholism. Possible resolutions of Gordis's views on abstinence with NIAAA research are (a) that those diagnosed alcohol dependent by DSM (both III-R and IV) are not really alcohol dependent and/or (b) that those categorized in remission are not. Untreated alcoholics in NLAES have less severe drinking problems than treated alcoholics. Perhaps they are not fully alcoholic. But what then is the significance of a DSM alcohol dependence diagnosis on which so many treatment decisions are made?

At the other end of the spectrum, the criticism might be that DSM-IV too readily finds drinkers are not categorizable as alcohol abusers/dependent. Many formerly dependent alcoholics in NLAES who now drink without abuse or dependence would not qualify for standard outcome definitions of moderate/social drinking. This is because American alcoholism researchers have become extremely cautious, not to say paranoid, about claiming that former alcoholics are drinking moderately. Yet, as indicated by the results MATCH proudly proclaimed, such reductions are clinically important. The public health term for this clinical improvement without full remission is "harm reduction."

Summary. NIAAA research shows that a medicalized conception of alcoholism and treatment is not suited to the nature and course of drinking problems. Project MATCH represents a massive effort to shoehorn a large amorphous peg into a small square hole. That it fails in this impossible task does not bother the health care industry, however. This is because, whether or not it accounts for the behavior of alcoholics, the medicalization of alcoholism succeeds in justifying the mission and policies of government and treatment agencies and professionals.

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