Absti for alcoholics reconsidered

The last reviews which concerned alcoholic abstinence either sum-marized data through 1963 or were submitted for publication in 1964. A decade later, it seems appropriate to update thinking on abstinence as a requisite for treatment of the alco-holic and as a criterion for evaluating therapeutic success. Hill and Blane (1967) found that abstinence was re-garded as a "near-universal " criterion of treatment for alcoholism. Al-though the overall picture has not changed markedly, there has been some re-evaluation of the concept. There certainly has been a shift away from the largely negative response to Davies ' (1962) disclosure that 7 of 93 treated alcoholics were drinking socially upon follow-up. Most of the treatment of chronic alcoholics has taken place in hospitals and there have been obvious reasons for insisting on sobriety. Structure has seemed most important for alcoholics, perceived as prone to act out and to lack inner controls. There is the long-standing proposition that limits are therapy for such patients. There is also the reality that with insobriety, one cannot fully avail 106 oneself of therapeutic modalities nor integrate the benefits which accrue therefrom. Equally valid is the fact that an alcoholic in treatment who drinks represents a negative and threatening model for fellow patients and a failure of their own efforts to the staff. Also, there is the partial reinforcement which devolves upon the alcoholic himself as well as his negative feedback about his ability to control drinking. Such alcoholics are often expelled from treatment pro-grams. It is no wonder, then, that a majority of mental health workers continue to insist upon abstinence. St. Augustine's statement that "to many, total abstinence is easier than perfect moderation " applies equally well to the alcoholic and to those who treat him. Of 480 V. A. psycho-logists, 71 percent chose abstinence as the criterion of successful treat-ment for alcoholism (Knox, 1969); 68 per cent of 1,674 psychiatrists and 90 per cent of other private practi-tioners believed.that "life-long" abstinence was the requisite goal (Jones and Helrich, 1972); of 71 social caseworkers, 93 per cent agreed that "alcoholics can neve