Abstinence is the total avoidance of an activity. It is the dominant approach in the United States to resolving alcoholism and drug abuse (e.g., "Just Say No"). Abstinence was at the base of Prohibition (legalized in 1919 with the Eighteenth Amendment) and is closely related to prohibitionism—the legal proscription of substances and their use.

Although temperance originally meant moderation, the nineteenth-century TEMPERANCE MOVEMENT'S emphasis on complete abstinence from alcohol and the mid-twentieth century's experience of the ALCOHOLICS ANONYMOUS movement have strongly influenced alcohol- and drug-abuse treatment goals in the United States. Moral and clinical issues have been irrevocably mixed.

The disease model of alcoholism and drug addiction, which insists on abstinence, has incorporated new areas of compulsive behavior—such as overeating and sexual involvements. In these cases, redefinition of abstinence to mean "the avoidance of excess" (what we would otherwise term moderation) is required.

Abstinence can also be used as a treatment-outcome measure, as an indicator of its effectiveness. In this case, abstinence is defined as the number of drug-free days or weeks during the treatment regimen—and measures of drug in urine are often used as objective indicators.

(SEE ALSO: Disease Concept of Alcoholism and Drug Addiction)

Bibliography

HEATH, D.B. (1992). Prohibition or liberalization of alcohol and drugs? In M. Galanter (Ed.), Recent developments in alcoholism Alcohol and cocaine. New York: Plenum.

LENDER, M. E., & MARTIN, J. K. (1982). Drinking in America. New York: Free Press.

PEELE, S., BRODSKY, A., & ARNOLD, M. (1991). The truth about addiction and recovery. New York: Simon & Schuster.

Controlled Drinking versus Abstinence

Stanton Peele

The position of ALCOHOLICS ANONYMOUS (AA) and the dominant view among therapists who treat alcoholism in the United States is that the goal of treatment for those who have been dependent on alcohol is total, complete, and permanent abstinence from alcohol (and, often, other intoxicating substances). By extension, for all those treated for alcohol abuse, including those with no dependence symptoms, moderation of drinking (termed controlled drinking or CD) as a goal of treatment is rejected (Peele, 1992). Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic's need to accept the reality that he or she can never drink in moderation.

In Britain and other European and Commonwealth countries, controlled-drinking therapy is widely available (Rosenberg et al., 1992). The following six questions explore the value, prevalence, and clinical impact of controlled drinking versus abstinence outcomes in alcoholism treatment; they are intended to argue the case for controlled drinking as a reasonable and realistic goal.

1. What proportion of treated alcoholics abstain completely following treatment?

At one extreme, Vaillant (1983) found a 95 percent relapse rate among a group of alcoholics followed for 8 years after treatment at a public hospital; and over a 4-year follow-up period, the Rand Corporation found that only 7 percent of a treated alcoholic population abstained completely (Polich, Armor, & Braiker, 1981). At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period.

In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers reported abstaining throughout a 2-year follow-up, although the figure was 37 percent for those assigned to a hospital program. According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment. Clearly, most research agrees that most alcoholism patients drink at some point following treatment.

2. What proportion of alcoholics eventually achieve abstinence following alcoholism treatment?

Many patients ultimately achieve abstinence only over time. Finney and Moos (1991) found that 49 percent of patients reported they were abstinent at 4 years and 54 percent at 10 years after treatment. Vaillant (1983) found that 39 percent of his surviving patients were abstaining at 8 years. In the Rand study, 28 percent of assessed patients were abstaining after 4 years. Helzer et al. (1985), however, reported that only 15 percent of all surviving alcoholics seen in hospitals were abstinent at 5 to 7 years. (Only a portion of these patients were specifically treated in an alcoholism unit. Abstinence rates were not reported separately for this group, but only 7 percent survived and were in remission at follow-up.)

3. What is the relationship of abstinence to controlled-drinking outcomes over time?

Edwards et al. (1983) reported that controlled drinking is more unstable than abstinence for alcoholics over time, but recent studies have found that controlled drinking increases over longer follow-up periods. Finney and Moos (1991) reported a 17 percent "social or moderate drinking" rate at 6 years and a 24 percent rate at 10 years. In studies by McCabe (1986) and Nordström and Berglund (1987), CD outcomes exceeded abstinence during follow-up of patients 15 and more years after treatment (see Table 1). Hyman (1976) earlier found a similar emergence of controlled drinking over 15 years.