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Giving Problem Drinkers an Option
The Orange County Register, December 5, 1988
By Cathy Lawhon
The wine connoisseur realizes he is overdoing it when he downs a bottle
each night with dinner. But he doesn't want to give up entirely.
A businessman started taking an occasional social drink to enhance the
give and take of his professional relationships. But now he is showing
up at the office with a hangover.
They are problem drinkers. And until recently, their only alternatives
were to try to cut down on their own or head for an alcohol treatment
program that promotes abstinence.
Now, however, a small, but growing contingent of psychologists and
doctors are saying problem drinkers can be taught to control and
moderate their habits without abstinence. Psychologist Marc F. Kern of
Addiction Alternatives in Tustin is among that controversial group.
"Let me say first that out of 20 people who come to me, I send probably
15 to abstinence," says Kern, who, at 40, has a busy psychology practice
that includes many problem drinkers. "They may come in desiring moderate
drinking, but from the results of their assessments, the chances of
success are so slim I refuse to treat for that goal.
"But there are others who find alcohol to be a pleasant part of their
lifestyle, and they don't want to give it up. It's really a personal
lifestyle decision that's not too different from other things we choose
in our lives that are potentially dangerous, like fast cars. It's hot
for me to say that abstinence really does provide a better overall life
style."
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The majority of health-care professionals in the treatment of alcohol
and most problem drinkers disagree.
"We have no axe to grind with anybody, but every once in a while someone
thinks they can do something like this, and we get a good laugh out of
it because for a real alcoholic it just won't work," says Ted C.,
hot-line volunteer at the Alcoholics Anonymous Orange County Central
Office.
"Alcoholics tell me they can't stop drinking, and I tell them,' Go ahead
and keep it up until you're hurting so bad you can't stand it anymore,"
Ted says. "When they're ready for treatment, they'll accept abstinence."
Kern and others who teach moderation, mainly in Europe and at the
Addiction Research Foundation in Toronto, admit their therapy is
controversial. A Rand Corporation study 10 years ago that concluded
moderate drinking is a stable, reliable goal for some problem drinkers
was "locked up in a cabinet and not allowed to come out," Kern says.
"And the medical community is strongly behind the disease model that
stresses abstinence for many good reasons and some not-so-admirable
reasons," he says. "The disease model does allow them to be reimbursed
for treatment."
Kern, however, says he offers a heaven for drinkers
who know they have a problem but are not willing to stop completely.
"There are, in my estimation, millions of people out there not seeking
treatment because the only treatment there are what I call strong
medicine approaches such as total, lifeline abstinence. Many people
don't want to stand up in a group and admit their problem, or they don't
believe in a higher power that they must turn over their lives to."
The treatment begins with a psychological assessment and family history.
Problem drinkers with two alcohol abusive family members are not a
candidate for the moderate program, Kern says.
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