An article by Harvard Health Publications on MSN Healthy Living makes the statement that "the research shows clearly that moderation is unlikely to be successful for patients who already meet criteria for dependence, whether defined by the DSM-IV or by a variety of assessment tools," and then goes on to cite data from Bill Miller's Behavioral Self Control Training (BSCT) which purportedly supports this statement. However, Miller's BSCT data does not support this conclusion at all.
Fifty four (54) of subjects in Miller's BSCT study had a diagnosis of Alcohol Dependence; the outcomes of these 54 after the BSCT intervention were as follows: abstinent 18, moderate 10, improved 10, unremitted 16.
Forty (40) subjects had a diagnosis of Alcohol Abuse with the following outcomes after treatment: abstinent 5, moderate 4, improved 12, unremitted 19.
There was no statistically significant difference between the number of moderators compared to the number of abstainers due to diagnosis of Dependence or Abuse; those with a diagnosis of Alcohol Dependence were just as likely to succeed at moderation as those with a diagnosis of Alcohol Abuse.
Miller also used scores on the MAST (Michigan Alcohol Screening Test) and the ADS (Alcohol Dependence Scale) to determine severity of Alcohol Dependence. Drinkers with MAST scores greater than 19 were classified as severely dependent. Miller found that severely dependent drinkers were significantly less likely to achieve a moderate drinking goal although they were successful at attaining either abstinence goals or harm reduction goals. Outcomes for the 36 severely dependent subjects were as follows: abstinent 13, moderate 2, improved 8, unremitted 15. (ADS scores produced no statistically significant differences.)
These studies lead us to the conclusion that drinkers with severe dependence will be most likely to succeed with either a goal of harm reduction or of abstinence and will be less likely to successfully achieve a goal of moderate drinking. Those who do not achieve abstinence or moderation ought to be steered in the direction of harm reduction.
These conclusions should not be surprising. NESARC found that about half of all people who recovered from Alcohol Dependence did so by cutting back. As early as 1981 Heather and Robertson published the book Controlled Drinking which demonstrated that moderate drinking outcomes were common among alcoholics. The Sobells also found similar outcomes as early as the 70s.
What should surprise us is the number of addiction treatment professionals who continue to spread the falsehood that it is impossible for those with Alcohol Dependence to achieve moderate drinking outcomes in spite of overwhelming scientific evidence to the contrary. Are they all just schills for 12 step programs which are based on divine revelation and not science? I really expected better of Harvard.
Miller, W. R., Leckman, A. L., Delaney, H. D., & Tinkcom, M. (1992). Long-term follow-up of behavioral self-control training. Journal of Studies on Alcohol, 53, 249-261.
Miller, W. R. & Taylor, C. A. (1980). Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers. Addict. Behav. 5: 13-24.
Miller, W. R., Taylor, C. A. & West, J.C. (1980). Focused versus broad-spectrum behavior therapy for problem drinkers. J. cons. clin. Psychol. 48: 590-601.
Miller, W. R., Walters, S. T., & Bennett, M. E. (2001). How effective is alcoholism treatment? Journal of Studies on Alcohol, 62, 211-220.
Miller, W. R., & Wilbourne, P. L. (2003). Whatever happened to controlled drinking? Alcoholism: Clinical and Experimental Research, 27(5, Supplement), 111A.