The idea of a controlled drinking program versus total abstinence as a way to effectively manage alcohol use disorder has been a controversial discussion that has recently gained even more attention. Traditional treatment programs are generally based on a model of total abstinence as a goal for all people with alcohol use disorders.
But today, with a better understanding of neuroscience, the development of new psychotherapies and medications since the founding of Alcoholics Anonymous, and the abstinence model 85 years ago, the concept of controlled drinking seems more of a real possibility for many who identify as having an alcohol problem. In fact, the idea of “harm reduction” as a way to cope with any substance abuse problem has recently been considered more acceptable in the addiction field.
Defining Alcoholism and Addiction
It is critical to understand how one defines an alcohol problem as not everyone who has an alcohol use disorder is an alcoholic. In addition, gaining a more comprehensive understanding of diagnosis and more modern methods of psychotherapy and medication can help more people get into treatment and, for some, allows for the possibility of sustaining a controlled drinking program.
AA’s Definition of Alcoholism
Today, at the foundation of most alcohol treatment and addiction programs are the principles of 12 Step Programs. Alcoholics Anonymous (AA) was the first 12 step program and is a spiritually based, self-help approach to the treatment of alcoholism that was started in the 1930s, in part, as a reaction to the fact that modern medicine at that time had no solution for alcoholism or addiction. Along with working through the 12 steps, finding God, and ongoing attendance to groups, abstinence is seen as the only way to deal with one’s alcoholism according to AA. Almost 100 years later, AA and the 12 step/abstinence model are still the cornerstones of treatment in most outpatient and inpatient treatment programs.
The Definition of Alcohol Abuse
Although abused by some, alcohol is a legal drug used by many people without any apparent major consequences. In fact, about 70% of people in the U.S. have had a drink in any given year, and approximately 5% of adults have an alcohol-related disorder. Terminology is confusing as it changes.
Currently, Psychiatry’s DSM 5 classifies it as Alcohol Use Disorder from “mild” to “moderate” to “severe,” depending on how many criteria a person meets. It is a maladaptive pattern of alcohol use that leads to significant impairment or distress as defined by the criteria listed in DSM 5.
The term “Alcoholism” is not a medical term but rather a term coined by Alcoholics Anonymous. “Alcoholic” is a self-defined term. On the other hand, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines “at-risk drinking” as greater than 14 drinks per week or 4 drinks on an occasion for healthy men under the age of 65, or 7 drinks per week and 3 on an occasion for women or men over 65. In addition, the NIAAA has classifications for “binge drinking,” where a person reaches a BAC of 0.08 g/dl or higher—usually after 5 drinks for a man and 4 drinks for a woman. About 25 % of adults report having had a binge drinking episode in the past month, while a new trend has developed called “high-intensity drinking,” wherein an individual drinks about twice as much as in a binge episode.
The Issue with Abstinence-Only Goals
There are many people who come for treatment for whom one drink truly is too many, and, in that case, abstinence as a goal is truly their best path forward. It is also true that most people do better with a goal of abstinence. We have seen this in our practice over the years. But the insistence on “abstinence-only” can repel many people from looking for help in the first place. Abstinence as the only solution really defies the idea that we are all individuals with different circumstances, motives, and goals.
Alcoholism, though a brain disease, is on a spectrum, that like any other disease, depending on where one is on that spectrum, guides treatment. At Fifth Avenue Psychiatry, we view it as more of a risk/benefit analysis of one’s drinking behavior, and if controlled drinking can fit into an acceptable risk/benefit equation, then it is possible. A very important caveat, however, is that one must have a careful assessment of one’s drinking patterns and previous consequences before embarking on a controlled drinking program.
Why is Abstinence of Alcohol Not for Everyone?
As there are many different definitions of alcoholism, there are many different types of people that come to treatment with different patterns of drinking. At Fifth Avenue Psychiatry, our alcohol addiction psychiatrists do not believe in a one-size-fits-all approach, nor do we believe a complete alcohol abstinence program serves every client right. In fact, only 7% of the 14.5 million Americans with AUD received treatment in the past year, and while there are some effective medications to help treat alcoholism, less than 4% were prescribed an FDA-approved medication for AUD. Additionally, people were more likely to see their doctor for an AUD-related medical problem than to get help for their AUD itself.
Binge Drinking VS Alcohol Use Disorder?
Binge drinking and heavy alcohol use are not, in themselves, disorders but can increase an individual’s risk of developing an Alcohol Use Disorder. The goal of any treatment for Alcohol Use Disorder (AUD) is seen as the restoration of a person’s medical and social well-being by control of alcohol drinking and its consequences.
Most treatment is geared toward abstinence, and for good reason, as statistics show that a person is more likely to recover from an AUD and stay recovered if the goal is abstinence.
Why People with Substance Use Disorders Don’t Seek Treatment
There are many reasons why people do not get treatment for substance use disorders and alcoholism. There is shame and embarrassment in admitting a problem, and there is denial (in that one may not even know they have a problem). At Fifth Avenue Psychiatry, our Manhattan alcohol addiction doctors believe two obstacles to getting help are the stigma of a one-size-fits-all program:
- The person with the AUD does not want to be labeled an “alcoholic” or “addict.”
- The person knows others will insist that they only seek abstinence-based treatment.
For these reasons, our award-winning Manhattan addiction doctors truly tailor treatment to an individual and one’s personal goals. We understand that not everyone can accept “abstinence as a goal” at first.
Discreet, Private Controlled Drinking Program in Manhattan
At Fifth Avenue Psychiatry, our Manhattan controlled drinking program is composed of two different phases.
- The Assessment Phase: This begins with our intake process where a person’s drinking behavior is analyzed. This includes history, frequency, and consequences to name a few. In addition, a person will typically start with a period of abstinence whose length of time is decided with one’s therapist. Sometimes medications are added to help with craving during this phase.
- The Evaluation/Abstinence Phase: Following the assessment phase, the patient will work on moderation management and mindfulness as it pertains to their drinking in combination with cognitive-behavioral therapies geared to help with moderation.
Are Medications Used to Treat Alcohol Addiction in a Controlled Drinking Program?
Medications, such as the following, can be added to reduce cravings and reduce consumption of alcohol:
Is a Manhattan Controlled Drinking Program Right for Me?
It is usually within this second phase where a person can truly make an assessment as to whether they benefit from a controlled drinking program. It is not always clear early on whether controlled drinking is possible, but with a good alliance with their therapist and honesty, one can be at peace with finding the right path—whether it be staying with a controlled drinking program in Manhattan or a self-directed decision to make abstinence the goal.
Individualized Alcohol Addiction Treatment in Manhattan
There are many people who struggle with their relationship with alcohol. Despite having consequences that affect their relationships, and sometimes work and health, they avoid treatment. For some, avoidance of treatment is truly just that, combined with denial. But many people who struggle with alcohol misuse can benefit from an approach where they can explore and get comfortable with their goals over time. For some, the idea of abstinence or 12-step programs may repel them from getting any help at all, and it may not be the appropriate solution. At Fifth Avenue Psychiatry we carefully assess and work with each client to find the appropriate treatment goals, whether that be a controlled drinking program or abstinence as a goal.